Korean J Hepatobiliary Pancreat Surg.  2012 Nov;16(4):142-146. 10.14701/kjhbps.2012.16.4.142.

Extent of resection for T2N0 gallbladder carcinoma regarding concurrent extrahepatic bile duct resection

• Gwark SC
• Hwang S
• Kim KH
• Lee YJ
• Park KM
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Lee SG

• KMID: 2243192
• DOI: http://doi.org/10.14701/kjhbps.2012.16.4.142

Abstract

BACKGROUNDS/AIMS
Gallbladder carcinoma (GBCa) T2 lesions are considered to be advanced tumors showing diverse features in tumor extent. When this T2 lesion does not involve the cystic duct and there is no evidence of lymph node metastasis, we have to consider what is the most reasonable extent of resection - that is, whether to perform concurrent extra-hepatic bile duct resection (EHBD) resection or not. This study intends to evaluate the adequacy of EHBD resection in patients undergoing resection for T2N0 GBCa.
METHODS
From our institutional database of GBCa, 48 cases of T2N0 GBCa who underwent R0 resection during November 1995 and August 2008 were selected. Patients who underwent prior laparoscopic cholecystectomy were excluded. Their medical records were reviewed retrospectively.
RESULTS
Their mean age was 63.2+/-83.3 years and females were 25. The mean serum CA19-9 level was 37.3+/-89.3 ng/ml. The extents of liver resection were wedge resection (n=36) and segment 4a+5 resection (n=12). Concurrent EHBD resection was performed in 16 (33.3%) patients. No fatal surgical complication occurred. The majority of tumor pathology was adenocarcinoma (n=42), with additional unusual types as papillary (n=3), saromatoid (n=1), signet ring cell (n=1) and adenosquamous (n=1) cancers. The overall survival rate was 87.1% at 1 year, 69.5% at 3 years and 61.7% at 5 years. After exclusion of mortalities not related to cancer, the overall patient survival rate was 89.6% at 1 year, 72.9% at 3 years and 64.7% at 5 years, with 3-year survival rates of 72% in the EHBD resection group and 69.2% in the non-resection group (p=0.661).
CONCLUSIONS
The results of this study indicate that concurrent EHBD resection did not improve patient survival when R0 resection was achieved in patients with T2N0 GBCa. Therefore, routine EHBD resection may not be indicated for T2N0 GBCa unless the tumor is close to the cystic duct.

Keyword

Gallbladder carcinoma; Extrahepatic bile duct resection; Extended cholecystectomy; Recurrence

MeSH Terms

Adenocarcinoma
Bile Ducts
Bile Ducts, Extrahepatic
Cholecystectomy, Laparoscopic
Cystic Duct
Female
Gallbladder
Humans
Liver
Lymph Nodes
Medical Records
Neoplasm Metastasis
Recurrence
Survival Rate

Figure

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  Fig. 1 The overall survival curve of 48 patients with pT2N0 gallbladder carcinoma.

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  Fig. 2 Comparison of the overall patient survival curves according to the extrahepatic bile duct resection.

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  Fig. 3 Comparison of the overall patient survival curves according to the extrahepatic bile duct resection, with exclusion of mortalities not related to cancer recurrence.

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