T2 Gallbladder Cancer Research Articles

Approach to T2 gallbladder cancer according to the tumor location and its surgical extent

Introduction: The clinical behavior of T2 gallbladder cancer varies among patients. The aims of this study were to identify prognostic factors for survival and recurrence, and to determine the optimal surgical strategy for T2 gallbladder cancer. Method: We conducted a retrospective analysis of 78 patients with T2 gallbladder cancer who underwent surgical resection for gallbladder cancer. Result: Twenty-eight (35.9%) patients underwent simple cholecystectomy and 50 (64.1%) underwent extended cholecystectomy. Among 56 patients without LN metastasis (n = 20) or unknown LN status (no LN dissection, n = 36), the 5-year disease-free survival rates were 81.6%, and 69.8% (P = 0.080). In an analysis according to tumor location, patients with tumors located on the hepatic side (n = 36) had a higher recurrence rate than patients with tumors located on the peritoneal side only (n = 35) (P = 0.043). On multivariate analysis, R1 resection and lymph node metastasis were significant, independent prognostic factors for poor disease-free and overall survival. Conclusion: R0 resection and LN dissection are an appropriate curative surgical strategy in patients with T2 gallbladder cancer. Tumors located on the hepatic side show worse prognosis than tumors located on the peritoneal side only, hepatic resection should be considered.

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.

Effects of the gross types in patients with T2 gallbladder cancer

Introduction: The 8th edition of the American Joint Committee on Cancer(AJCC) guidelines categorize T2 gallbladder cancers according to pathologic tumor location: peritoneal tumors are categorized as peritoneal-side(T2a) tumors and hepatic tumors are categorized as hepatic-side(T2b) tumors. This change in classification was based on the results of an international multicenter study that take into account the impact of tumor location. We hypothesize that the tumor gross type of gallbladder cancer is more important than tumor location. This study aimed to investigate the role of gross type of gallbladder cancers in T2 stage. Method: We performed 86 cholecystectomy in patients with gallbladder cancer from Feb. 2008 to Dec. 2017. We reviewed retrospectively medical records of 30 patients who had pathologically confirmed T2 stage Gallbladder cancer. Result: Twenty-six patients underwent initially simple cholecystectomy and among them, five patients underwent re-operation after diagnosis. Only four patients underwent extended cholecystectomy. The number of expansive type is 8(26.7%), infiltrative type is 18(60%) and unknown type is 4(13.3%). The rate of lymph node (LN) metastasis (n=8, 44.4%), lymphovascular invasion (n=12, 66.7%) and perineural invasion (n=8, 44.4%) are more high in infiltrative type group. Mean disease free survival (DFS) (77month vs 36month, p=0.059) and overall survival (OS) (64 month vs 40 month, p=0.161) are also poor in infiltrative type group. However it did not show significant difference. Conclusion: Although Our results did not show significant DFS and OS difference because of small sample size, the tumor gross type of T2 gallbladder cancer may be important prognostic factor. Using the more larger scale data, the whether the tumor gross type or tumor location are more important prognostic factor must be evaluated.

The optimal surgical extent of T2 gallbladder cancer and the effect of location of the tumor

Introduction: T2 gallbladder cancer (GBC) is subcategorized into T2a and T2b depending on the location. While extended cholecystectomy (EC) is surgery of choice for T2 GBC, some argue that simple cholecystectomy (SC) is enough for T2a. The aim was to validate the subcategorization of T2 GBC and to explore its proper surgical extent. Method: Data on 957 pathologically proven T2 GBC patients who received curative surgery were collected from Korea, Japan, Chile, and the United States. Clinical, pathological, and radiologic data were reviewed. Survival analyses were performed. Result: The median survival duration was 152 months and the 5-year survival rate (5YSR) was 71.7%. EC was performed in 724 patients (75.7%) and SC in 233 patients (24.3%). Lymph node (LN) was harvested in 81.5%. The mean size of tumor was 3.5 cm. R0 was achieved in 94.3%. T2a consisted 44.1% (N=422), T2b 50.2% (N=480), and undetermined 5.7%. LN metastasis was found in 29.0% (N=277). Recurrence occurred in 27.9% (N=267). EC group had significantly superior outcome compared to SC group (5YSR 73.0% vs. 61.7%, p=0.017). T2a had significantly better survival than T2b (5YSR 74.3% vs. 66.8%, p=0.017). For T2a, EC (N=328) had better survival compared to SC (N=94) but it was insignificant (5YSR 76.3% vs. 66.7%, p=0.207). In contrast, EC (N=374) had significantly better survival compared to SC (N=106) in T2b (5YSR 70.0% vs. 55.2%, p=0.013). Elevated CA19-9, SC, R1, and LN metastasis were independently associated with recurrence. Recurrence rate, pattern, and location were not different between T2a and T2b. Conclusion: The prognosis of T2 GBC differs according to the location which supports subcategorization into T2a and T2b. EC offers superior outcome over SC. This is true for T2b, but the statistical significance is lost in T2a. However, given the 10% 5YSR difference, SC with LN dissection should be reserved only for selected T2a GBC patients.

Different Surgical Strategies of T2 Gallbladder Cancer According to Tumor Location?: a Korea Tumor Registry System-BiliaryPancreas (KOTUS-BP) Database Analysis

Different Surgical Strategies of T2 Gallbladder Cancer According to Tumor Location?: a Korea Tumor Registry System-BiliaryPancreas (KOTUS-BP) Database Analysis

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

Surgical outcome of T2 gallbladder cancer based on location of tumor and surgical treatments

Introduction: This study aimed to determine the prognostic impact of tumor location and suggest the optimal surgical stretagy in T2 gallbladder cancer (GBCA). Methods: 131 patients with T2 GBCA underwent R0 resection from 1994 to 2014. The location was categorized as “hepatic side” versus “peritoneal side” and “fundus” versus “body” versus “neck” through preoperative image. Results: Among the 131 patients with T2 GBCA, the most significant predicting factor for the survival and recurrence is the nodal status. The 5-year survival rate (5-YSR) was 96.8% for the N0 patients and 79.4% for the N1 patients. Survival was no statistical difference according to location. With respect to surgical procedure, 5-YSR for patients with peritoneal-side cancer was no significant difference according to hepatic resection (HR). However, the 5-YSR was 96.2% for hepatic-side patient with HR, and 60% for those without HR HR was important factor associated with survival in patients with hepatic-side cancer (p = 0.021). 5-YSR was no statistical difference according to bile duct resection (BDR) in the patients with fundus and body-located tumor. Although the difference was not statistically significant, survival of neck-located patients with BDR was better than that of patients without BDR. 5-YSR was 100% for patient with neck-located cancer with BDR, and 79.5% for those without BDR. Conclusions: Considering the location of tumor, the optimal procedure for each patients should be considered. In patients with hepatic-side cancer, HR is effective procedure for improving survival. BDR is considered to be additional procedure for improving survival in selected patient with neck-located cancer.

Oncologic outcome of T2 gallbladder cancer and the optimal surgical treatment: Korean multi-institutional analysis

Oncologic outcome of T2 gallbladder cancer and the optimal surgical treatment: Korean multi-institutional analysis

Approach to T2 gallbladder cancer according to the tumor location and its surgical extent

Approach to T2 gallbladder cancer according to the tumor location and its surgical extent

Prognostic validation of the updated 8th edition Tumor-Node-Metastasis classification by the Union for International Cancer Control: Survival analyses of 307 patients with surgically treated gallbladder carcinoma.

In December 2016, the Union for International Cancer Control (UICC) published the 8th edition of the Tumor-Node-Metastasis (TNM) classification of malignant tumors, including a number of vital changes in the definitions of the T2 category, the N category and the stages of gallbladder cancer (GBC). The clinical value of this newly updated classification in patients with surgically treated GBC has not been rigorously validated. The present study aimed to analyze the prognosis of patients with GBC in a high-volume surgical unit, and to validate the prognostic value of the new UICC TNM classification, particularly the main changes in the stages of GBC. Data from 307 patients who were surgically treated and histopathologically diagnosed with GBC between January 2011 and July 2016 in The West China Hospital (Chengdu, Sichuan, China) were retrospectively collected and analyzed. The new UICC criteria distributed 32, 60, 99 and 116 eligible patients in stages I, II, III and IV, respectively. The differences in overall survival time between each stage (I–IV) demonstrated statistical significance (P<0.05). As a result of the main change of this classification, the novel definitions of T2a and T2b effectively stratified the prognosis of patients with T2 GBC (P<0.001). Furthermore, patients with stage IIa tumors also obtained significantly improved overall survival time compared with patients with stage IIb tumors (P=0.04), whereas the comparison between patients with stage IIb and IIIa tumors did not present any notable difference (P=0.20). Additionally, the new N category stratified the survival of the patients effectively (P<0.001). Together with curative resection, this latest classification was indicated to be an independent predictor of survival via multivariate analysis (hazard ratio, 6.25; 95% confidence interval, 3.81–10.26; P<0.001). In conclusion, the newly updated UICC TNM classification could effectively reflect the clinical outcome of patients with surgically treated GBC. Furthermore, tumor location could predict the survival of surgically treated T2 GBC. The novel classification of the N category by the number of lymph nodes involved was also demonstrated to be valid.

Significance of bile duct resection for advanced gallbladder cancer without biliary infiltration

BackgroundAlthough hepatectomy IVa + V with bile duct resection (BDR) for T2 gallbladder cancer (GBC) is performed in our institution, limited surgery is occasionally selected. This study aimed to clarify the significance of BDR for advanced GBC without biliary infiltration. MethodsSixty-seven patients were enrolled who underwent surgery for pT2 or higher GBC without biliary infiltration. The patient disposition, demographics, clinicopathologic factors, disease-free survival (DFS) and overall survival (OS) were compared between the BDR group (n = 33) and non-BDR group (n = 34). ResultsThere were no significant differences in TNM factors, R0 rate, morbidity rate and rate of adjuvant chemotherapy between the two groups. The patients in the BDR group were significantly younger, had more lymph nodes harvested than those in the non-BDR group, and more frequently underwent hepatectomy IVa + V and extended lymphadenectomy. There were no significant differences in the OS and DFS rates between the two groups. ConclusionThe significance of BDR for pT2 or higher advanced GBC without biliary infiltration was equivocal because the patients received no survival benefit by undergoing BDR.

High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

BackgroundCurrent consensus guidelines suggest that gallbladder cancer (GBC) patients with resected T1a disease can be observed while patients with T1b or greater lesions should undergo lymphadenectomy (LNE). The primary aim of this study was to critically explore the impact of LNE in early-stage GBC on overall survival (OS) on a population-based level. MethodThe 2004–2014 National Cancer Database was reviewed to identify non-metastatic GBC patients with T1a, T1b, or T2 disease and grouped whether a dedicated LNE was performed. OS and relative survival were assessed using Cox proportional hazard regression analyses before and after propensity score adjustments. Results4015 patients were included, 246 (6%) had T1a, 654 (16%) T1b, and 3115 (78%) T2 GBC. The rate of positive lymph nodes was 13%, 12%, and 40% for T1a, T1b, and T2 tumors, respectively. Even after propensity score adjustment, no OS benefit was found if LNE was performed for T1a disease (HR:0.63, 95%CI:0.35–1.13) while OS was improved for T1b (HR:0.65, 95%CI:0.49–0.87) and T2 tumors (HR:0.65, 95%CI:0.57–0.73). ConclusionDespite a higher rate of nodal positivity among patients with T1a disease compared to previous reports, there was no impact on survival and current treatment guidelines appear appropriate for the management of T1a disease.

The association between preoperative serum interleukin-6 levels and postoperative prognosis in patients with T2 gallbladder cancer.

Interleukin-6 (IL-6) is closely associated with tumor progression. Whether it can predict postoperative prognosis of patients with T2 gallbladder cancer (GBC) remains controversial. We retrospectively collected the medical records of 125 patients with T2 GBC. Then, we analyzed the association between preoperative serum IL-6 levels and postoperative survival by multivariate Cox analyses and Kaplan-Meier curves in exploratory subgroups. Predictive effects of serum IL-6 levels on overall survival were similar across most of the evaluated subgroups, except in different tumor location subgroups. The independent odds ratio (OR) of serum IL-6 levels was 2.57 (95%CI 1.73-3.82) in the hepatic side subgroup, while it was 1.15 (95%CI 0.68-1.93) in the peritoneal side subgroup (P = 0.014 for interaction). When we categorized serum IL-6 levels by median value (4.2 pg/mL), the 5-year survival rate of patients with high serum IL-6 levels was significantly higher in the hepatic side subgroup (58.5% vs 14.8%, P < 0.001), but no such difference was found in the peritoneal side subgroup (62.2% vs 67.6%, P = 0.722). Preoperative serum IL-6 is significantly associated with prognostic implications in patients with hepatic side T2 GBC, not in those with peritoneal side tumors.

Revision of nationwide practice patterns in the management of T2 gallbladder carcinoma

Background: National guidelines recommend en-bloc hepatectomy and lymphadenectomy for stage IB and higher gallbladder cancer (GBC). Compliance with these guidelines has been poor. We sought to assess potential changes in the practice patterns in the surgical management of T2 GBC over the last 3 decades. Methods: A contemporary series from National Cancer Database (NCDB) was queried for patients with T2 disease who underwent resection for GBC from 2004 to 2014 (Period 2). This data was compared with an older large series from SEER (Surveillance Epidemiology End-results) database including T2 GBC patients between 1991 and 2005 (Period 1). Kaplan–Meier log-rank analyses assessed the impact of the definitive surgical approach on survival rates. Results: NCDB and SEER databases identified 11,532 and 2,955 patients, respectively. Among them, 618 (5.3%) and 781 (26.4%) T2 GBC were included in this analysis, respectively. Patients undergoing hepatectomy had improved survival in both periods compared to those who did not undergo hepatectomy (51.7 vs. 25.3 months, p < 0.001 and 53.0 vs. 16.0 months, p < 0.001, respectively). Hepatectomy rates increased by 36% from period 1 to period 2 (13.4% vs. 37.2%, p < 0.001). Portal lymphadenectomy increased by 66.4% between period 1 and period 2 (33.3% vs. 50.1%, p < 0.001). Conclusion: Although there was a significant improvement in the compliance with national guidelines over last 3 decades, major disparities yet exist in the current surgical management of GBC. Only one third of patients with T2 GBC currently undergo appropriate hepatectomy and half of them undergo portal lymphadenectomy. Further studies assessing the impact of noncompliance on outcomes of patients with GBC are warranted. Efforts should be directed towards standardization of nationwide practice patterns in GBC.

Surgical Strategy for T2 Gallbladder Cancer: Nationwide Multicenter Survey in Korea.

BackgroundAlthough all guidelines suggest that T2 gallbladder (GB) cancer should be treated by extended cholecystectomy (ECx), high-level scientific evidence is lacking because there has been no randomized controlled trial on GB cancer.MethodsA nationwide multicenter study between 2000 and 2009 from 14 university hospitals enrolled a total of 410 patients with T2 GB cancer. The clinicopathologic findings and long-term follow-up results were analyzed after consensus meeting of Korean Pancreas Surgery Club.ResultsThe 5-year cumulative survival rate (5YSR) for the patients who underwent curative resection was 61.2%. ECx group showed significantly better 5YSR than simple cholecystectomy (SCx) group (65.4% vs. 54.0%, P = 0.016). For N0 patients, there was no significant difference in 5YSR between SCx and ECx groups (68.7% vs. 73.6%, P = 0.173). Systemic recurrence was more common than locoregional recurrence (78.5% vs. 21.5%). Elevation of cancer antigen 19-9 level preoperatively and lymph node (LN) metastasis were significantly poor prognostic factors in a multivariate analysis.ConclusionECx including wedge resection of GB bed should be recommended for T2 GB cancer. Because systemic recurrence was more common and recurrence occurred more frequently in patients with LN metastasis, postoperative adjuvant therapy should be considered especially for the patients with LN metastasis.

The optimal surgical resection approach for T2 gallbladder carcinoma: evaluating the role of surgical extent according to the tumor location

PurposeThe clinical behavior of T2 gallbladder cancer varies among patients. The aims of this study were to identify prognostic factors for survival and recurrence, and to determine the optimal surgical strategy for T2 gallbladder cancer.MethodsWe conducted a retrospective analysis of 78 patients with T2 gallbladder cancer who underwent surgical resection for gallbladder cancer.ResultsTwenty-eight patients (35.9%) underwent simple cholecystectomy and 50 (64.1%) underwent extended cholecystectomy. Among 56 patients without LN metastasis (n = 20) or unknown LN status (no LN dissection, n = 36), the 5-year disease-free survival rates were 81.6%, and 69.8% (P = 0.080). In an analysis according to tumor location, patients with tumors located on the hepatic side (n = 36) had a higher recurrence rate than patients with tumors located on the peritoneal side only (n = 35) (P = 0.043). On multivariate analysis, R1 resection and lymph node metastasis were significant, independent prognostic factors for poor disease-free and overall survival.ConclusionR0 resection and LN dissection are an appropriate curative surgical strategy in patients with T2 gallbladder cancer. Tumors located on the hepatic side show worse prognosis than tumors located on the peritoneal side only, hepatic resection should be considered.

Role of common bile duct resection in T2 and T3 gallbladder cancer patients.

Backgrounds/AimsRoutine bile duct resection as part of the typical oncological resection for patients with advanced gallbladder cancer remains controversial with regard to, ultimately, curative value. The aim of this study was to compare oncological outcomes for patients undergoing surgery for gallbladder cancer with or without bile duct resection.MethodsWe recruited, for the purpose of this study, all patients who underwent surgical resection for T2 and T3 gallbladder cancer at Severance hospital, Seoul, Korea, during the period January 2000 and December of 2011. The patient data was reviewed retrospectively.ResultsThe patients (n=149) recruited to participate in the study were divided into two groups according to their bile duct resection status: The bile duct resection group (BDR group, n=54); and, the bile duct non-resection group (BDNR group, n=95). Significant difference was found in lymph node retrieval between BDR and BDNR groups (15 vs. 5, respectively with p<0.001). There was no significant difference between the two groups with regard to the five year survival rate (43% in BDR group vs. 57% in BDNR group, p=0.339). Following multivariate analysis, lymph node metastasis, advanced T-stage, and total retrieved lymph nodes <6 were independent prognostic factors for poor survival in patients with T2 and T3 gallbladder cancer.ConclusionsThe findings revealed by the current study suggest that the role of bile duct resection might be limited to improved staging, and offers no advantage in long-term survival. However, in view of the foregoing and given the minimal increase in morbidity associated with BDR, it should be actively considered as a treatment option for patients who present with findings suspicious for invasion around hepatoduodenal ligament.

Optimal extent of surgery for early gallbladder cancer with regard to long-term survival: a meta-analysis.

The optimal surgical extent for T1 gallbladder cancer (GBC) remains controversial. Simple cholecystectomy is routinely performed for T1 GBC while several guidelines recommend extended cholecystectomy for T1b GBC. However, evidence regarding the optimal surgical extent for T1 GBC is lacking. This study aims to systematically evaluate the optimal surgical extent for early GBC with regard to long-term survival. A comprehensive literature search in MEDLINE was performed to identify studies with histologically proven GBC and survival data. A total of 22 articles with a total of 2,578 patients were included in the final analysis. Dichotomous data regarding cancer-related death in all T1, T1a, and T1b GBC cases were extracted. Risk ratios, risk differences, and 95% confidence intervals (CIs) were pooled. The risk ratio between simple and extended cholecystectomy in T1 GBC patients was 1.06 (95% CI 0.97-1.16); T1a, 0.82 (95% CI 0.70-0.96); and T1b, 1.06 (95% CI 0.93-1.22). No significant difference was found according to the extent of surgery in all T1 or T1b GBC cases (P = 0.17 and P = 0.36, respectively). Simple cholecystectomy had significantly lower cancer-related death in T1a GBC patients (P = 0.01). Simple and extended cholecystectomy showed comparable survival outcomes in T1 GBC patients.

Do hepatic-sided tumors require more extensive resection than peritoneal-sided tumors in patients with T2 gallbladder cancer? Results of a retrospective multicenter study

Tumor location is a prognostic factor for survival in patients with T2 gallbladder cancer. However, the optimal extent of resection according to tumor location remains unclear. We reviewed the records of 192 patients with T2 gallbladder cancer who underwent R0 or R1 resection at 6 institutions. Perioperative and oncologic outcomes were compared according to the extent of resection between hepatic-sided (n=93) and peritoneal-sided (n=99) tumors. After a median follow-up of 30months, the 5-year overall survival (84.9% vs 71.8%, P=.048) and recurrence-free survival (74.6% vs 62.2%, P=.060) were greater in peritoneal-sided T2 patients than in hepatic-sided T2 patients. Among hepatic-sided T2 patients, the 5-year overall survival was greater in patients who underwent radical cholecystectomy including lymph node dissection with liver resection than in patients who underwent lymph node dissection without liver resection (80.3% vs 30.0%, P=.032), and the extent of liver resection was not associated with overall survival (P=.526). Lymph node dissection without liver resection was an independent prognostic factor for overall survival in hepatic-sided T2 gallbladder cancer (hazard ratio 5.009, 95% confidence interval 1.512-16.596, P=.008). In peritoneal-sided T2 patients, the 5-year overall survival was not significantly different between the lymph node dissection with liver resection and the lymph node dissection without liver resection subgroups (70.5% vs 54.8%, P=.111) and the extent of lymph node dissection was not associated with overall survival (P=.395). In peritoneal-sided T2 gallbladder cancer, radical cholecystectomy including lymph node dissection without liver resection is a reasonable operative option. Radical cholecystectomy including lymph node dissection with liver resection is suitable for hepatic-sided T2 gallbladder cancer.

Surgical practice patterns and outcomes in T2 and T3 gallbladder cancer: insights from a population based study

Objective: To describe management and outcomes in patients with resected T2 and T3 gallbladder cancer (GBC) in the general population of Ontario, Canada. Methods: All cases of resected T2 and T3 GBC from 2002 to 2012 were identified using the Ontario Cancer Registry. Electronic treatment records and pathology reports were linked to the registry to describe surgical management and pathologic findings. Type of resection was classified as ‘extended’ (cholecystectomy + liver resection +/− bile duct resection) or ‘simple’ (cholecystectomy only). Results: 24% (56/232) of T2 cases and 37% (51/138) of T3 cases underwent an extended resection. Unadjusted overall 5-year survival for simple vs extended resection was 39.7% vs 49.5% for T2 GBC (p=0.03) and 13.5% vs 22.8% for T3 GBC (p=0.05). In adjusted analysis of T2 cases, extended resection significantly improved overall survival (HR=0.51; 95% CI 0.30 to 0.97), while higher grade of differentiation, presence of lymphovascular invasion and positive lymph nodes lead to worse survival. In adjusted analysis of T3 cases, only younger age and female gender significantly improved overall survival, along with a strong trend for node negative disease. Extended resection demonstrated a trend for improved survival among node negative cases (HR=0.20; CI 0.03–1.06). Conclusion: The use of extended resection for T2 and T3 GBC in Ontario is modest and overall survival is comparable to high-volume centres. Extended resection is associated with improved overall survival in all T2 disease and limited to node negative T3 disease.