Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study

Abstract

Background In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection. Methods Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA. Survival and risk factor analyses were conducted. Results Data from 937 patients were available for evaluation. The overall 5-year disease-free survival rate was 70 center dot 6 per cent, 74 center dot 5 per cent for those with T2a and 65 center dot 5 per cent among those with T2b tumours (P = 0 center dot 028). Regarding liver resection, extended cholecystectomy was associated with a better 5-year disease-free survival rate than simple cholecystectomy (73 center dot 0 versus 61 center dot 5 per cent; P = 0 center dot 012). The 5-year disease-free survival rate was marginally better for extended than simple cholecystectomy in both T2a (76 center dot 5 versus 66 center dot 1 per cent; P = 0 center dot 094) and T2b (68 center dot 2 versus 56 center dot 2 per cent; P = 0 center dot 084) disease. Five-year disease-free survival rates were similar for extended cholecystectomies including liver wedge resection versus segment IVb/V segmentectomy (74 center dot 1 versus 71 center dot 5 per cent; P = 0 center dot 720). In multivariable analysis, independent risk factors for recurrence were presence of symptoms (hazard ratio (HR) 1 center dot 52; P = 0 center dot 002), R1 resection (HR 1 center dot 96; P = 0 center dot 004) and N1/N2 status (N1: HR 3 center dot 40, P < 0 center dot 001; N2: HR 9 center dot 56, P < 0 center dot 001). Among recurrences, 70 center dot 8 per cent were metastatic. Conclusion Tumour location was not an independent prognostic factor in T2 gallbladder cancer. Extended cholecystectomy was marginally superior to simple cholecystectomy. A radical operation should include liver resection and adequate node dissection.