J Korean Med Sci.  2018 Jul;33(28):e186. 10.3346/jkms.2018.33.e186.

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

Affiliations
  • 1Department of Surgery, Chung-Ang University School of Medicine, Seoul, Korea.
  • 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. jangjy4@snu.ac.kr
  • 3Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, Chonbuk National University College of Medicine, Jeonju, Korea.
  • 5Department of Surgery, Konyang University College of Medicine, Daejeon, Korea.
  • 6Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
  • 7Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Korea.
  • 8Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
  • 9Department of Surgery, Sungkyunkwan University College of Medicine, Seoul, Korea.
  • 10Department of Surgery, Center for Liver Cancer, National Cancer Center, Goyang, Korea.
  • 11Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Abstract

BACKGROUND
Although 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.
METHODS
A 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.
RESULTS
The 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.
CONCLUSION
ECx 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.

Keyword

Gallbladder; Carcinoma; Simple; Extended; Cholecystectomy

MeSH Terms

Cholecystectomy
Consensus
Follow-Up Studies
Gallbladder Neoplasms*
Gallbladder*
Hospitals, University
Humans
Korea*
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Pancreas
Recurrence
Survival Rate
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