Surgical strategy for T2 and T3 gallbladder cancer

Is extrahepatic bile duct resection always necessary?

Sae-Byeol Choi, Hyung Joon Han, Wan-Bae Kim, Taejin Song, Sung Ock Suh, Sang Yong Choi

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: Resection of the extrahepatic bile duct is not performed uniformly in gallbladder cancer. The study investigated the clinical significance of resection of extrahepatic bile duct (EHBD) in T2 and T3 gallbladder cancer. Methods: Between 2000 and 2010, 71 T2 or T3 gallbladder cancer patients who underwent R0 resection at Korea University Medical Center were included. Clinicopathological data were reviewed retrospectively. Survival analysis and comparison between EHBD resection and non-resection groups were performed. Results: The 32 men and 39 women had 49 T2 tumors and 22 T3 tumors. The overall survival rate was 67.8 % at 3 years and 47.2 % at 5 years. In multivariate analysis for overall survival, lymphovascular invasion and lymph node metastasis were significant independent predictors. Comparing the patients according to EHBD resection, the EHBD resection group demonstrated significantly longer hospital stay, longer operative time, more transfusion requirement, more extensive liver resection, and less treatment of neoadjuvant therapy. Significantly higher proportions of perineural invasion and lymph node metastasis were noted in the EHBD resection group. There were no statistically significant differences in survival between the EHBD resection and non-resection groups. Conclusions: Resection of extrahepatic bile duct was not always necessary in T2 and T3 cancers. However, the patients who undergo resection of extrahepatic bile duct tended to have more aggressive tumor characteristics and undergo more aggressive surgical approach. To enhance overall survival for the patients with T2 and T3 gallbladder cancers, surgeons should try to perform R0 resection including EHBD resection.

Original languageEnglish
Pages (from-to)1137-1144
Number of pages8
JournalLangenbeck's Archives of Surgery
Volume398
Issue number8
DOIs
Publication statusPublished - 2013 Dec 1

Fingerprint

Gallbladder Neoplasms
Extrahepatic Bile Ducts
Survival
Neoplasms
Lymph Nodes
Neoplasm Metastasis
Neoadjuvant Therapy
Survival Analysis
Korea
Operative Time
Length of Stay
Multivariate Analysis
Survival Rate

Keywords

  • Extrahepatic bile duct resection
  • Lymph node metastasis
  • T2 gallbladder cancer
  • T3 gallbladder cancer

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical strategy for T2 and T3 gallbladder cancer : Is extrahepatic bile duct resection always necessary? / Choi, Sae-Byeol; Han, Hyung Joon; Kim, Wan-Bae; Song, Taejin; Suh, Sung Ock; Choi, Sang Yong.

In: Langenbeck's Archives of Surgery, Vol. 398, No. 8, 01.12.2013, p. 1137-1144.

Research output: Contribution to journalArticle

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abstract = "Purpose: Resection of the extrahepatic bile duct is not performed uniformly in gallbladder cancer. The study investigated the clinical significance of resection of extrahepatic bile duct (EHBD) in T2 and T3 gallbladder cancer. Methods: Between 2000 and 2010, 71 T2 or T3 gallbladder cancer patients who underwent R0 resection at Korea University Medical Center were included. Clinicopathological data were reviewed retrospectively. Survival analysis and comparison between EHBD resection and non-resection groups were performed. Results: The 32 men and 39 women had 49 T2 tumors and 22 T3 tumors. The overall survival rate was 67.8 {\%} at 3 years and 47.2 {\%} at 5 years. In multivariate analysis for overall survival, lymphovascular invasion and lymph node metastasis were significant independent predictors. Comparing the patients according to EHBD resection, the EHBD resection group demonstrated significantly longer hospital stay, longer operative time, more transfusion requirement, more extensive liver resection, and less treatment of neoadjuvant therapy. Significantly higher proportions of perineural invasion and lymph node metastasis were noted in the EHBD resection group. There were no statistically significant differences in survival between the EHBD resection and non-resection groups. Conclusions: Resection of extrahepatic bile duct was not always necessary in T2 and T3 cancers. However, the patients who undergo resection of extrahepatic bile duct tended to have more aggressive tumor characteristics and undergo more aggressive surgical approach. To enhance overall survival for the patients with T2 and T3 gallbladder cancers, surgeons should try to perform R0 resection including EHBD resection.",
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