Surgical resection for T1b gallbladder cancer: Is radical resection necessary?

Abstract

Introduction: There is no consensus on the overall performance of radical resection for T1b gallbladder cancer (GBC). This research focused to address whether T1b GBC may spread loco-regionally and radical resection is necessary. Method: A retrospective analysis of 47 patients with T1b GBC, 29 (62%) of whom underwent simple cholecystectomy and 18 (38%) radical resection with regional lymph node dissection at our center and its affiliated institutions between January 1982 and December 2018, was performed. Result: There was no vascular or perineural invasion in any patient on histology evaluation, except for lymphatic vessel invasion in a single patient. There were no metastases to all analyzed lymph nodes. For all 47 patients, cumulative 10- and 20-year overall survival rates were 65% and 25%, respectively. Surgical outcome of simple cholecystectomy (10-year overall survival rate of 66%) was similar to that of radical resection (that of 64%, P = 0.618). Two patients who experienced radical resection deceased from tumor relapse in distant sites (liver and lung). For all 47 patients, cumulative 10- and 20-year disease-specific survival rates were 93% and 93%, respectively. The outcome following simple cholecystectomy (10-year disease-specific survival rate of 100%) was equivalent to that after radical resection (that of 86%, P = 0.151). While age (> 70 years, hazard ratio 5.285, P = 0.003) and gender (male, hazard ratio 3.672, P = 0.007) had a strong adverse effect on patient overall survival, surgical procedure (simple cholecystectomy vs. radical resection) did not. Conclusion: Most T1b GBCs are local disease. As pre-operative diagnosis including tumor penetration of T1b GBC is difficult, the performance of radical resection is justified. Additional radical resection is not required following simple cholecystectomy provided that the penetration depth is restricted towards the muscular layer, and surgical margins are uninvolved.