Prognostic Effect of Liver Resection in Extended Cholecystectomy for T2 Gallbladder Cancer Revisited

Abstract

Objective: This study aimed to evaluate the effect of liver resection on the prognosis of T2 gallbladder cancer (GBC). Background: Although extended cholecystectomy [lymph node dissection (LND) + liver resection] is recommended for T2 GBC, recent studies have shown that liver resection does not improve survival outcomes relative to LND alone. Methods: Patients with pT2 GBC who underwent extended cholecystectomy as an initial procedure and did not reoperation after cholecystectomy at 3 tertiary referral hospitals between January 2010 and December 2020 were analyzed. Extended cholecystectomy was defined as either LND with liver resection (LND+L group) or LND only (LND group). We conducted 2:1 propensity score matching to compare the survival outcomes of the groups. Results: Of the 197 patients enrolled, 100 patients from the LND + L group and 50 from the LND group were successfully matched. The LND + L group experienced greater estimated blood loss (P < 0.001) and a longer postoperative hospital stay (P = 0.047). There was no significant difference in the 5-year disease-free survival (DFS) of the 2 groups (82.7% vs 77.9%, respectively, P = 0.376). A subgroup analysis showed that the 5-year DFS was similar in the 2 groups in both T substages (T2a: 77.8% vs 81.8%, respectively, P = 0.988; T2b: 88.1% vs 71.5%, respectively, P = 0.196). In a multivariable analysis, lymph node metastasis [hazard ratio (HR) 4.80, P = 0.006] and perineural invasion (HR 2.61, P = 0.047) were independent risk factors for DFS; liver resection was not a prognostic factor (HR 0.68, P = 0.381). Conclusions: Extended cholecystectomy including LND without liver resection may be a reasonable treatment option for selected T2 GBC patients.

Prognostic factors for resected cases with gallbladder carcinoma: a systematic review and meta-analysis

“…A total of 26 studies 9 , 10 , 16 , 17 , 23 , 28 – 30 , 32 , 33 , 36 , 38 , 39 , 41 – 45 , 47 – 51 , 54 – 56 with 4603 cases were incorporated. Pooled results indicated that lymph node metastasis was a validating risk factor for OS (HR=2.78, 95% CI: 2.35–3.28, P <0.00001) (Figure S1F, Supplemental Digital Content 4, http://links.lww.com/JS9/C302 ) (Table 2 ).…”

“…A total of 8 studies 28 , 29 , 32 , 38 , 42 , 43 , 45 , 48 with 1615 cases were incorporated. Pooled results indicated that vascular invasion was a risk factor for OS among resected cases with GBC (HR=2.28, 95% CI: 1.87–2.79, P <0.00001) (Figure S1I, Supplemental Digital Content 4, http://links.lww.com/JS9/C302 ) (Table 2 ).…”

“…A total of 14 studies 9 , 16 , 17 , 23 , 28 , 32 , 37 , 42 , 44 , 45 , 49 – 51 , 57 with 7929 cases were incorporated. Pooled results indicated that postoperative adjuvant chemotherapy was a protective factor but was not a prognostic factor for OS among resected GBC (HR=0.96, 95% CI: 0.80–1.16, P =0.70000) (Figure S1P, Supplemental Digital Content 4, http://links.lww.com/JS9/C302 ) (Table 2 ).…”

“…Peri-neural invasion was demonstrated to be an independent prognostic factor on OS or DFS in resected patients with intrahepatic cholangiocarcinoma 68 . Similarly, based on the evidence regarding GBC patients, peri-neural invasion also indicated a worse prognosis 13 , 16 – 18 , 23 , 28 – 30 , 38 , 41 – 43 , 45 , 46 , 49 , 55 , 57 . Subsequently, when their results were pooled together, we were surprisingly to find that patients with peri-neural invasion shared a two times risk of death than those without peri-neural invasion (HR=2.20, P <0.00010) and it also served as an independent prognostic factor (HR=1.34, P =0.02000)…”

New trends in diagnosis and management of gallbladder carcinoma

“…A multivariate analysis showed lymph node involvement and perineural invasion, but not the absence of liver resection, as risk factors for worse survival outcomes. The researchers recommended T2 stage extended cholecystectomy with lymphadenectomy, without hepatic segment IV and V resection in selected cases[ 101 ]. Perineural invasion has been considered an important indicator of early recurrence and worse prognosis.…”