T1b Gallbladder Research Articles

IRON: A retrospective international multicenter study on robotic versus laparoscopic versus open approach in gallbladder cancer

ObjectiveFor patients with T1b gallbladder cancer or greater, an adequate lymphadenectomy should include at least 6 nodes. Studies comparing short- and long-term outcomes of the open approach with those of laparoscopy and robotic approaches are limited, with small sample sizes, and there are none comparing laparoscopic and robotic approaches. This study compared patients who underwent robotic, laparoscopic, and open resection of gallbladder cancer, evaluating short- and long-term outcomes. MethodsWe conducted a multicenter retrospective study of patients with T1b gallbladder cancer or greater (excluding combined organ resection and T4) who underwent open, laparoscopic, and robotic liver resection and lymphadenectomy between January 2012 and December 2022. The 3 groups were matched in terms of patient baseline and disease characteristics based on propensity score matching, comparing robotic with open and robotic with laparoscopic groups. ResultsWe enrolled 575 patients from 37 institutions. After propensity score matching, the median number of harvested nodes was higher in the robotic group than in the open (7 vs 5; P = .0150) and laparoscopic groups (7 vs 4; P < .001). The Pringle maneuver time was shorter with robotic resection than with laparoscopy (38 vs 59 minutes; P = .0034), and the robotic group also had a lower conversion rate (3% vs 14%, respectively; P = .005) and less estimated blood loss than open and laparoscopic resections. The perioperative morbidity and mortality rates did not differ. The robotic and laparoscopic approaches were associated with faster functional recovery than the open group. In the multivariate analysis, the factors related to the retrieval of at least 6 nodes were the robotic approach over open (odds ratio, 5.1529) and over laparoscopy (odds ratio, 6.7289) and the center experience (≥20 minimally invasive liver resections/year) (odds ratio, 4.962). After a mean follow-up of 42.6 months, overall survival and disease-free survival were not different between groups. ConclusionCompared with open and laparoscopic surgeries, the robotic approach for gallbladder cancer performed in a center with appropriate experience in minimally invasive surgery can provide adequate node retrieval.

Simple versus radical cholecystectomy and survival for pathologic stage T1B gallbladder cancer

BackgroundRadical cholecystectomy is recommended for T1B and greater gallbladder cancer, however, there are conflicting reports on the utility of extended resection for T1B disease. Herein, we characterize outcomes following simple and radical cholecystectomy for pathologic stage T1B gallbladder cancer. MethodsThe National Cancer Database (NCDB) was queried for patients with pathologic T1B gallbladder cancer diagnosed from 2004 to 2018. Patients were stratified by surgical management. Overall survival (OS) was compared with Kaplan–Meier and multivariable Cox proportional hazards methods. ResultsAltogether, 950 patients were identified with pathologic T1B gallbladder cancer: 187 (19.7 %) receiving simple and 763 (80.3 %) radical cholecystectomy. Median OS was 89.5 (95 % CI 62.5–137) and 91.4 (95 % CI 75.9–112) months for simple and radical cholecystectomy, respectively (log-rank p = 0.55). Receipt of simple cholecystectomy was not associated with greater hazard of mortality compared to radical cholecystectomy (HR 1.23, 95 % CI 0.95–1.59, p = 0.12). DiscussionIn this analysis, we report comparable outcomes with simple cholecystectomy among patients with pathologic T1B gallbladder cancer. These findings suggest that highly selected patients, such as those with R0 resection and imaging at low risk for residual disease and/or nodal metastasis, may not benefit from extended resection; however, radical cholecystectomy remains standard of care until prospective validation can be achieved.

Risk factors of lymph node metastasis in patients with T1b gallbladder cancer

BACKGROUND: Whether radical surgery or simple cholecystectomy should be performed on patients with stage T1b gallbladder cancer remains controversial. To explore the effect of lymph node metastasis on the prognosis of patients with stage T1b gallbladder cancer is very crucial for guiding the treatment and follow-up of T1b gallbladder cancer patients.METHODS: A retrospective analysis of the surveillance, epidemiology and end results (SEER) database was performed. Patients with stage T1b gallbladder cancer that underwent surgery and pathologic nodal staging were identified. Logistic regression and Cox regression were performed to identify independent predictors and prognostic factors, respectively.RESULTS: Of 427 patients (age: 69.1±13.2 years, 72.1% females), 31 (7.2%) had lymph node metastasis. In multivariable analysis, higher histology grade was independent risk factor associated with the diagnosis of the patient lymph node metastasis. In the entire cohort, lymph node metastasis indicated a worse overall survival (HR [95%CI]: 3.83 (1.54-9.47), P<0.01) and disease-specific survival (HR [95%CI]: 3.46(1.54-7.82), P<0.01) in multivariable analysis. Lymph node metastasis, in multivariable analysis, showed statistical difference for worse OS (HR [95%CI]: 4.04(1.20-13.65), P=0.02) and DSS (HR [95%CI]: 3.25(1.10-9.57), P=0.03) in moderately differentiation group.CONCLUSIONS: Higher histology grade was an independent risk factor for lymph node metastasis. Lymph node metastasis was an independent prognostic factor of worse OS and DSS. Lymph node metastasis showed statistical difference for worse OS and DSS in moderately and advanced differentiation groups, a finding that could guide the choice of surgery.

Minimally invasive radical cholecystectomy as a safe alternative to open radical cholecystectomy

Background: Gallbladder cancer today accounts for an estimated 1.2% of all new cancer diagnoses worldwide. For localized stage T1b gallbladder cancer and above, the treatment of choice is a radical cholecystectomy with negative gross and histologic margins. This procedure involves removal of the gallbladder and a portion of the liver, with or without concurrent resection of the bile duct and regional lymph nodes. In the past, performing this resection laparoscopically has been contraindicated due to fears of increased metastasis and inadequate lymph node sampling. With the advancement of laparoscopic techniques, however, minimally invasive radical cholecystectomies have the potential to be as safe and effective as the classic, open approach. This study seeks to use the current available literature to compare outcomes between an open and a laparoscopic radical cholecystectomy.

Reappraisal of T1b gallbladder cancer (GBC): clinicopathologic analysis of 473 in situ and invasive GBCs and critical review of the literature highlights its rarity, and that it has a very good prognosis.

There are highly conflicting data on relative frequency (2-32%), prognosis, and management of pT1b-gallbladder carcinoma (GBC), with 5-year survival ranging from > 90% in East/Chile where cholecystectomy is regarded as curative, versus < 50% in the West, with radical operations post-cholecystectomy being recommended by guidelines. A total of 473 in situ and invasive extensively sampled GBCs from the USA (n = 225) and Chile (n = 248) were re-evaluated histopathologically per Western invasiveness criteria.349 had invasive carcinoma, and only 24 were pT1. Seven cases previously staged as pT1b were re-classified as pT2. There were 19 cases (5% of all invasive GBCs) qualified as pT1b andmost pT1b carcinomas were minute (< 1mm). One patient with extensive pTis at margins(but pT1b focus away from the margins) died of GBC at 27months, two died of other causes, and the remainder were alive without disease (median follow-up 69.9months; 5-year disease-specific survival, 92%). In conclusion, careful pathologic analysis of well-sampled cases reveals that only 5% of invasive GBCs are pT1b, with a 5-year disease-specificsurvival of > 90%, similar to findings in the East. This supports the inclusion of pT1b in the "early GBC" category, as is typically done inhigh-incidence regions. Pathologic mis-staging of pT2 as pT1 is not uncommon. Cases should not be classified as pT1b unless extensive, preferably total, sampling of the gallbladder to rule out a subtle pT2 is performed. Critical appraisal of the literature reveals that the Western guidelines are based on either SEER or mis-interpretation of stage IB cases as "pT1b." Although the prognosis of pT1b-GBC is very good, additional surgery (radical cholecystectomy) may be indicated, and long-term surveillance of the biliary tract is warranted.

Simple cholecystectomy is an adequate treatment for grade I T1bN0M0 gallbladder carcinoma: Evidence from 528 patients

BACKGROUNDT1b gallbladder carcinoma (GBC) is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver. However, controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection.AIMTo explore the optimal surgical approach in patients with T1b gallbladder cancer of different pathological grades.METHODSPatients with T1bN0M0 GBC who underwent surgical treatment between 2000 and 2017 were included in the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier method and log-rank test were used to analyze the overall survival (OS) and disease-specific survival (DSS) of patients with T1b GBC of different pathological grades. Cox regression analysis was used to identify independent predictors of mortality and explore the selection of surgical methods in patients with T1b GBC of different pathological grades and their relationship with prognosis.RESULTSOf the 528 patients diagnosed with T1bN0M0 GBC, 346 underwent simple cholecystectomy (SC) (65.5%), 131 underwent SC with lymph node resection (SC + LN) (24.8%), and 51 underwent radical cholecystectomy (RC) (9.7%). Without considering the pathological grade, both the OS (P < 0.001) and DSS (P = 0.003) of T1b GBC patients who underwent SC (10-year OS: 27.8%, 10-year DSS: 55.1%) alone were significantly lower than those of patients who underwent SC + LN (10-year OS: 35.5%, 10-year DSS: 66.3%) or RC (10-year OS: 50.3%, 10-year DSS: 75.9%). Analysis of T1b GBC according to pathological classification revealed no significant difference in OS and DSS between different types of procedures in patients with grade I T1b GBC. In patients with grade II T1b GBC, obvious survival improvement was observed in the OS (P = 0.002) and DSS (P = 0.039) of those who underwent SC + LN (10-year OS: 34.6%, 10-year DSS: 61.3%) or RC (10-year OS: 50.5%, 10-year DSS: 78.8%) compared with those who received SC (10-year OS: 28.1%, 10-year DSS: 58.3%). Among patients with grade III or IV T1b GBC, SC + LN (10-year OS: 48.5%, 10-year DSS: 72.2%), and RC (10-year OS: 80%, 10-year DSS: 80%) benefited OS (P = 0.005) and DSS (P = 0.009) far more than SC (10-year OS: 20.1%, 10-year DSS: 38.1%) alone.CONCLUSIONSimple cholecystectomy may be an adequate treatment for grade I T1b GBC, whereas more extensive surgery is optimal for grades II-IV T1b GBC.

Node positivity in T1b gallbladder cancer: A high volume centre experience

IntroductionIdentification of early stage gallbladder cancer (GBC) is difficult with simple cholecystectomy being considered curative for T1a GBC but T1b requires radical cholecystectomy due to chances of lymph node metastasis. However there is no consensus regarding the optimal treatment strategy for T1b disease. MethodologyA retrospective review of a prospectively maintained database of GBC patients operated at our institute from March 2010 to March 2021 was conducted. Only patients with proven gallbladder adenocarcinoma on final histopathology report were included. ResultsA total of 1245 patients of suspected GBC who underwent surgery during this period with 76 patients of T1b stage were analysed. We divided the group into a node positive cohort (n = 16, 9 received neoadjuvant treatment due to uptake in periportal nodes and 7 patients were pN1) and a node negative cohort (n = 60). The median nodal harvest was 8 nodes (2–24 nodes). Considering the radiological and pathological parameters, the rate of lymph node positivity was 21% (16/76). The overall major morbidity was 5.2% and there was no mortality. After a median follow up of 47.5 months, 3-year OS and DFS of the node negative and positive cohort was 96.7%, 91.7% and 75% and 62.5% (p = 0.058). The node positive cohort had 43% recurrences whereas the node negative cohort had 8.3% with all recurrences limited to periportal lymph nodes, distant nodes or liver metastasis. ConclusionNodal positivity for T1b gall bladder cancer ranges around 21% and radical surgery with complete peri –portal lymphadenectomy should be considered as standard of care.

Node Positivity in T1b Gallbladder Cancer: A High Volume Centre Experience

Introduction: Identification of early stage gallbladder cancer is difficult which is why about half of the patients are diagnosed post simple cholecystectomy . Simple cholecystectomy is considered adequate for T1a gall bladder cancer, however T1b requires radical cholecystectomy due to chances of lymph node metastasis. Methods: A retrospective review of a prospectively maintained database of gall bladder cancer patients operated at our institute from March 2010 to March 2021 was conducted. Only patients with proven gallbladder adenocarcinoma on final histopathology report were included. Results: There were a total of 1,245 patients of upfront and revision surgery for gall bladder cancer in this period. There were 76 patients of T1b stage of which 11 patients underwent upfront surgery and 65 patients were diagnosed as incidental gall bladder carcinoma. Neoadjuvant treatment was given to 9 patients due to uptake in periportal nodes and they were excluded from final analysis. The median age was 50 years (28-72 years). The median nodal harvest was 8 nodes (2-24 nodes). Positive nodes were found in 7 (10.44%) out of 67 patients with pT1b in final histopathology report. After a median follow up of 47.5 months (range 2-120 months), 7 (10.4%) patients had succumbed due to disease, 2 were alive with disease and 3 were lost to follow up with an OS of 89% and DFS of 86%. Conclusion: Nodal positivity for T1b gall bladder cancer ranges around 10% and radical surgery with complete peri –portal lymphadenectomy should be considered as standard of care.

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China.

BACKGROUNDWhether regional lymphadenectomy (RL) should be routinely performed in patients with T1b gallbladder cancer (GBC) remains a subject of debate. AIMTo investigate whether RL can improve the prognosis of patients with T1b GBC.METHODSWe studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China. The log-rank test and Cox proportional hazards model were used to compare the overall survival (OS) of patients who underwent cholecystectomy (Ch) + RL and those who underwent Ch only. To investigate whether combined hepatectomy (Hep) improved OS in T1b patients, we studied patients who underwent Ch + RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTSOf the 121 patients (aged 61.9 ± 10.1 years), 77 (63.6%) underwent Ch + RL, and 44 (36.4%) underwent Ch only. Seven (9.1%) patients in the Ch + RL group had lymph node metastasis. The 5-year OS rate was significantly higher in the Ch + RL group than in the Ch group (76.3% vs 56.8%, P = 0.036). Multivariate analysis showed that Ch + RL was significantly associated with improved OS (hazard ratio: 0.51; 95% confidence interval: 0.26-0.99). Among the 77 patients who underwent Ch + RL, no survival improvement was found in patients who underwent combined Hep (5-year OS rate: 79.5% for combined Hep and 76.1% for no Hep; P = 0.50).CONCLUSIONT1b GBC patients who underwent Ch + RL had a better prognosis than those who underwent Ch. Hep + Ch showed no improvement in prognosis in T1b GBC patients. Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines, RL was only performed in 63.6% of T1b GBC patients. Routine Ch + RL should be advised in T1b GBC.

Rates, Predictors, and Outcomes of Portal Lymphadenectomy for Resectable Gallbladder Cancer.

Lymphadenectomy (LND) is recommended following surgical resection of ≥ T1b gallbladder cancer (GBC). However, frequency and stage-specific survival benefits of LND remain unclear. The National Cancer Database (NCDB; 2006-15) was queried for resected pathologic stage I-III GBC. LND performance, predictors of receiving LND, and LND association with overall survival (OS) were assessed. Of 2302 total patients, 1343 (58.3%) underwent LND. Patients who underwent LND were younger and more frequently had private health insurance, a negative surgical margin, higher pathologic T stage, and received adjuvant chemotherapy (all p < 0.001). LND rates were highest at academic centers (70.1%) relative to all other facility types (p < 0.001). LND was independently associated with improved OS [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.44-0.61]. LND was associated with improved OS for pT1b, pT2, and pT3 patients (all p < 0.05) on univariate analysis. LND was independently associated with improved OS in pT2 (HR 0.44, CI 0.35-0.56) and pT3 (HR 0.54, CI 0.43-0.69) patients. LND is associated with a 48% reduction in risk of death in patients with resectable non-metastatic GBC, with greatest impact in pT2-3 patients. Patients without LND have similar OS to patients with node-positive disease, highlighting the importance of LND. Underutilization of LND likely results in undertreatment of patients with undiagnosed nodal disease, which may contribute to unfavorable oncologic outcomes.

Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China.

Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p < 0.01) and shorter duration of postoperative hospital stay (6.2 ± 2.4 vs 8.6 ± 2.3; p < 0.01). There was no statistically significant difference between two groups for lymph nodes yield (5.4 ± 3.5 vs 5.8 ± 2.1; p > 0.05), incidence of lymphatic metastasis (15% vs 16.67%; p > 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12-29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma.

Survival benefits of simple versus extended cholecystectomy and lymphadenectomy for patients with T1b gallbladder cancer: An analysis of the surveillance, epidemiology, and end results database (2004 to 2013).

Although guidelines recommend extended surgical resection, radical resection and lymphadenectomy for patients with tumor stage (T)1b gallbladder cancer, these procedures are substantially underutilized. This population‐based, retrospective cohort study aimed to evaluate treatment patterns and outcomes of 401 patients using the US Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Results showed that median overall survival (OS) was 69 months for lymphadenectomy patients and 37 months for those without lymphadenectomy. Lymphadenectomy also tended to prolong cancer‐specific survival (CSS), although the differences were not statistically significant. OS and CSS were similar for patients who received simple cholecystectomy and extended surgical resection. Cox proportional hazards regression models revealed survival advantages in patients with stage T1bN0 gallbladder cancer compared to those with stage T1bN1, and patients who received simple cholecystectomy plus lymphadenectomy compared to those who did not receive lymph node dissection. In further analyses, patients undergoing simple cholecystectomy who had five or more lymph nodes excised had better OS and CSS than those without lymph node dissection. In conclusion, survival advantages are shown for patients with T1b gallbladder cancer undergoing surgeries with lymphadenectomy. Future studies with longer follow‐up and control of potential confounders are highly warranted.

Radiofrequency ablation of gallbladder bed in radical surgery for stage T1b gallbladder cancer

Objective To study the value of radiofrequency ablation of gallbladder beds in radical surgery for stage T1b gallbladder cancer. Methods A retrospective study was conducted on 21 patients with stage T1b gallbladder cancer treated in the Department of Hepatobiliary Pancreas and Spleen Surgery, West Campus, Beijing Chaoyang Hospital, Capital Medical University, from April 1, 2011 to March 31, 2019. Patients who were diagnosed with frozen section during operation were included into the surgery group. Patients who were diagnosed postoperatively and underwent radical surgery for the gallbladder carcinoma were included in the secondary surgery group. The differences in surgical time, bleeding volume, survival rate, and survival time between the two groups after regular follow-up were compared, and the 5-year cumulative survival rates and overall survival time of the two groups were calculated. Results All patients underwent radical gallbladder cancer surgery. There were 14 males and 7 females, aged from 26 to 70 (49.0±13.5) years. There were no perioperative deaths. There were 15 patients in the operation group, and 6 patients in the secondary surgery group. The bleeding volume of the surgery group was significantly less than the secondary surgery group [(101.3±35.5) ml vs. (177.0±44.6) ml, P 0.05). The 5-year cumulative survival rate for the two groups of patients was 56.5%, and the overall survival time was (79.0±9.3) months. Conclusions Radiofrequency ablation of the gallbladder bed was safe and effective in radical surgery of T1b gallbladder cancer. For T1b stage gallbladder cancer, which is difficult to diagnose during surgery, secondary radical surgery achieved the same results as primary radical surgery. Key words: Gallbladder neoplasms; Radiofrequency ablation; T1b stage; Gallbladder bed

Long-term outcomes of surgical resection for T1b gallbladder cancer: an institutional evaluation

BackgroundThere is no comprehensive agreement concerning the overall performance of radical resection for T1b gallbladder cancer (GBC). This research focused on addressing whether T1b GBC may spread loco-regionally and whether radical resection is necessary.MethodsA retrospective analysis was conducted of 1032 patients with GBC who underwent surgical resection at our centre and its affiliated institutions between January 1982 and December 2018. A total of 47 patients with T1b GBC, 29 (62%) of whom underwent simple cholecystectomy and 18 (38%) of whom underwent radical resection with regional lymph node dissection, were enrolled in the study.ResultsGBC was diagnosed pre-operatively in 16 patients (34%), whereas 31 patients (66%) had incidental GBC. There was no blood venous or perineural invasion in any patient on histology evaluation, except for lymphatic vessel invasion in a single patient. There were no metastases in any analysed lymph nodes. The open surgical approach was more prevalent among the 18 patients who underwent radical resection (open in all 18 patients) than among the 29 patients who underwent simple cholecystectomy (open in 21; laparoscopic in 8) (P = 0.017). The cumulative 10- and 20-year overall survival rates were 65 and 25%, respectively. The outcome following simple cholecystectomy (10-year overall survival rate of 66%) was akin to that following radical resection (64%, P = 0.618). The 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 following radical resection (that of 86%, P = 0.151). While age (> 70 years, hazard ratio 5.285, P = 0.003) and gender (female, hazard ratio 0.272, P = 0.007) had a strong effect on patient overall survival, surgical procedure (simple cholecystectomy vs. radical resection) and surgical approach (open vs. laparoscopic) did not.ConclusionsMost T1b GBCs represent local disease. As pre-operative diagnosis, including tumour penetration of T1b GBC, is difficult, the decision 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 that surgical margins are uninvolved.

Simple Cholecystectomy Is Adequate for Patients With T1b Gallbladder Adenocarcinoma < 1 cm in Diameter.

Purpose: Consensus-based clinical guidelines recommend that simple cholecystectomy (SC) is adequate for T1a gallbladder adenocarcinoma (GBA), but extended cholecystectomy (EC), SC plus lymphatic dissection, should be considered for T1b and more advanced GBA. Whether lymphatic dissection is necessary for the treatment of T1b GBA remains controversial. This study attempts to better define the current criteria for local treatment of T1b GBA, by examining the relationship between lymph node (LN) metastasis and tumor size in such patients.Patients and methods: Clinical data from patients with T1b GBA receiving curative surgical treatment between 2004 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Baseline characteristics for the entire cohort were described, and overall survival (OS) and cancer-specific survival (CSS) were analyzed with the Kaplan–Meier method.Results: In total, 277 patients were enrolled for further analysis; 127 underwent lymphadenectomy. Among them, 23 patients had tumors <1 cm in diameter, none of which had LN metastasis; 104 patients had tumors ≥1 cm, 15 of which had positive LNs. In the group with tumor size <1 cm, there was no significant survival difference between treatment with SC or EC (P = 0.694). A clinical benefit was observed in T1b GBA patients with a tumor size ≥1 cm receiving EC vs. those receiving SC (P = 0.012).Conclusion: SC was adequate for treatment of T1b GBA < 1 cm in diameter. This evidence may be included as part of current guidelines.

The appropriate surgical strategy for T1b gallbladder cancer incidentally diagnosed after a simple cholecystectomy.

Backgrounds/AimsThe appropriate surgical treatment was investigated for T1b gallbladder (GB) cancer through a retrospective analysis of the clinical outcomes of patients with incidental T1 GB cancer.MethodsPatients with T1 GB cancer who were incidentally diagnosed while undergoing a simple cholecystectomy at Chungnam University Hospital from January 2004 to December 2017 were enrolled. Overall, 39 patients with T1 GB cancer, 17 patients with T1a, and 22 patients with T1b were included. We retrospectively analyzed the patients' clinical and pathologic findings and follow-up results.ResultsAmong the 6490 patients who underwent cholecystectomy during the study period, 165 patients were diagnosed with GB cancer (T1=42 [25.5%]). The risk factor associated with recurrence and cancer-related death in patients with T1 GB cancer was lymphovascular invasion (recurrence, p=0.028; death, p=0.004). In the T1b group, the 5-year disease-free survival (DFS) rate showed a statistical difference between patients with and without lymphovascular invasion (45.7% vs. 83.6%, p=0.048). There was no statistically significant difference in 5-year DFS and overall survival rate between simple cholecystectomy and extended cholecystectomy in T1b GB cancer with lymphovasular invasion (p=0.054 and p=0.091, respectively).ConclusionsIn incidental T1b GB cancer, extended cholecystectomy was not superior to simple cholecystectomy in terms of the 5-year DFS rate and nor in overall survival rate or recurrence rate, even when lymphovascular invasion was identified after simple cholecystectomy. Therefore, simple cholecystectomy may be recommended as a primary surgical strategy for T1b GB cancer.

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

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.

Optimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study.

There is no consensus on the optimal treatment of T1b gallbladder cancer (GBC) due to the lack of evidence and the difficulty of anatomy and pathological standardization. A total of 272 patients with T1b GBC who underwent surgical resection at 14 centers with specialized hepatobiliary-pancreatic surgeons and pathologists in Korea, Japan, Chile, and the United States were studied. Clinical outcomes including disease-specific survival (DSS) rates according to the types of surgery were analyzed. After excluding patients, the 237 qualifying patients consisted of 90 men and 147 women. Simple cholecystectomy (SC) was performed in 116 patients (48.9%) and extended cholecystectomy (EC) in 121 patients (51.1%). The overall 5-year DSS was 94.6%, and it was similar between SC and EC patients (93.7% vs. 95.5%, P=0.496). The 5-year DSS was similar between SC and EC patients in America (82.3% vs. 100.0%, P=0.249) as well as in Asia (98.6% vs. 95.2%, P=0.690). The 5-year DSS also did not differ according to lymph node metastasis (P=0.688) or tumor location (P=0.474). SC showed similar clinical outcomes (including recurrence) and survival outcomes as EC; therefore, EC is not needed for the treatment of T1b GBC.

National Failure of Surgical Staging for T1b Gallbladder Cancer.

Current guidelines recommend radical cholecystectomy with regional lymphadenectomy (RC-RL) for patients with T1b gallbladder cancer (GBC). However, the extent to which these guidelines are followed is unclear. This study aimed to evaluate current surgical practices for T1b GBC and their implications for overall management strategies and associated outcomes. This retrospective cohort study investigated patients identified from the National Cancer Data Base (2004-2012) with non-metastatic T1b GBC. The patients were categorized according to type of surgical treatment received: simple cholecystectomy (SC) or RC-RL. Among the patients who had lymph nodes pathologically examined, nodal status was classified as pN- or pN+. Use of any adjuvant therapy was ascertained. Overall survival (OS) was compared based on type of surgical treatment and nodal status. The cohort comprised 464 patients (247 SC and 217 RC-RL cases). The positive margin status did not differ between the two groups (6.1% for SC vs 2.3% for RC-RL; p = 0.128). For RC-RL, the pN+ rate was 15%. Adjuvant therapies were used more frequently in pN+ (53.1% vs 9.4% for pN-). By comparison, 10.9% of the SC patients received adjuvant therapy. The OS for RC-RL-pN- (5-years OS, 64.4%) was significantly better than for RC-RL-pN+ (5-years OS, 15.7%) or SC (5-years OS, 48.3%) (p < 0.001). Less than 50% of the patients with a T1b GBC primary tumor undergo the recommended surgical treatment. Given that 15% of these patients have nodal metastasis and in light of the previously described benefits of adjuvant therapy for node positive GBC, failure to perform RC-RL risks incomplete staging and thus undertreatment for patients with T1b GBC.

The comparison between laparoscopic and open radical cholecystectomy at T1b & T2 gallbladder cancer

The comparison between laparoscopic and open radical cholecystectomy at T1b & T2 gallbladder cancer