Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma.
BACKGROUND
This study aimed to identify a subgroup of patients with inapparent T2 gallbladder carcinoma who may be best suited for radical second resection.


METHODS
A retrospective analysis was conducted of 126 patients with pathologic stage T2 (pT2) gallbladder carcinoma (51 with clinically evident tumor and 75 with inapparent tumor). Depth of subserosal invasion was measured histologically in each gallbladder specimen. The median follow-up period was 113 months.


RESULTS
In all 126 patients, depth of subserosal invasion was the strongest independent prognostic factor by univariate (P <.0001) and multivariate (relative risk, 9.27; P <.0001) analyses. Among the 75 patients with inapparent tumor, the outcome after resection was significantly better in patients who had undergone radical second resection than in patients who had undergone cholecystectomy alone (P =.0006). When depth of subserosal invasion was divided into <or=2 vs. >2 mm, the effectiveness of radical second resection remained only in patients with subserosal invasion >2 mm (P =.0004).


CONCLUSIONS
Depth of subserosal invasion best predicts postresectional long-term survival of pT2 gallbladder carcinoma patients. Among patients with inapparent pT2 tumors, those with subserosal invasion >2 mm are good candidates for radical second resection.
Wakai
Toshifumi
T
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Shirai
Yoshio
Y
Yokoyama
Naoyuki
N
Ajioka
Yoichi
Y
Watanabe
Hidenobu
H
Hatakeyama
Katsuyoshi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis