Surgical treatment of pT2 gallbladder carcinoma: a reevaluation of the therapeutic effect of hepatectomy and extrahepatic bile duct resection based on the long-term outcome.
BACKGROUND
The clinical indications for hepatectomy and extrahepatic bile duct resection (EBDR) for pT2 gallbladder carcinoma (GBC) remains controversial. The aim of this study is to elucidate the therapeutic effect of hepatectomy and extrahepatic bile duct resection on the surgical treatment of pT2 GBC.


METHODS
Ninety-four patients with pT2 GBC who underwent a potentially curative resection were retrospectively analyzed regarding their pathological findings, surgical procedures, and survival.


RESULTS
The most powerful predicting factor for the survival is the nodal status. The 5-year survival rate was 87.1% for the pN0 patients and 55.7% for the pN1 patients. With respect to surgical procedures, the 5-year survival rate was 73.3% for the 51 patients with hepatectomy, and 87.2% for the 43 patients without hepatectomy. In addition, the 5-year survival rate was 66.7% for the 11 patients with EBDR, and 81.1% for the 83 patients without EBDR. When restricting the patients to those with pN1 disease, the 5-year survival rate of the patients who received these procedures did not surpass that of the patients who did not.


CONCLUSIONS
There is no positive therapeutic effect besides providing surgical margins in hepatectomy and EBDR in the surgical treatment of pT2 GBC whereas lymph node dissection is most effective procedure for improving survival. Provided that the negative surgical margins are secured, a hepatectomy and an EBDR can therefore be withheld in the surgical treatment for the pT2 GBC.
Yokomizo
Hiroshi
H
Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Kumamoto 861-8520, Japan. h-yokomizo@kumamoto-med.jrc.or.jp
Yamane
Takaaki
T
Hirata
Toshihiko
T
Hifumi
Michio
M
Kawaguchi
Tetsu
T
Fukuda
Seiji
S
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome