Does "clinical" R0 have validity in the choice of simple cholecystectomy for gallbladder carcinoma?
BACKGROUND
This study was designed to evaluate the survival outcomes of patients undergoing simple cholecystectomy and to investigate which patients would benefit from cholecystectomy alone in treating gallbladder carcinoma.


METHODS
The available medical records of patients who underwent cholecystectomy alone for gallbladder carcinomas from August 1992 to February 2005 were retrospectively reviewed. Cancer stages were evaluated by clinical meaning based on the AJCC Cancer Staging Manual, 6th edition. "Clinical" R0, defined as gallbladder confined tumor (pT1-3 with negative resection margin) with cN0 and cM0, was tentatively established to evaluate the quality of simple cholecystectomy.


RESULTS
Seventy-five patients underwent cholecystectomy alone for gallbladder carcinomas. Twenty-eight patients were male, and forty-seven patients were female, with their mean age 63.5 years (range, 29-80 years). Forty-one patients (54.7%) underwent laparoscopic cholecystectomy, and thirty-four patients (45.3%) underwent open cholecystectomy. T3 lesions were most common (26 patients), followed by T1 (24 patients), T2 (19 patients), and T4 (6 patients). "Clinical R0" could be defined in 48 patients (63%) after simple cholecystectomy. Multivariate analysis showed that incidental gallbladder carcinoma, T stage, and clinical R0 status were independent prognostic factors of long-term survival. When comparing survival outcomes of clinical R0 according to the T stage, no patients with Tis, T1a, and T1b had cancer-related mortality during follow-up. Especially, in patients with T2 gallbladder carcinomas, the mean survival rate was 68.9 months, and the 5-year survival rate was 77.8%. On the contrary, those with T3 lesions had poor prognoses.


CONCLUSIONS
Cholecystectomy alone could be proper management for well-selected patients with gallbladder carcinomas (incidental gallbladder carcinoma, gallbladder confined carcinoma, clinical R0). More experiences and a proper prospective study must be performed to confirm the meaning of clinical R0 in treating gallbladder carcinoma.
Department of Surgery, Yonsei University College of Medicine, Institute of Gastroenterology, Yonsei University Health System, 250 Seonsanno, Seodaemun-gu, Seoul 120-752, South Korea.
Chang Moo
CM
Kang
Woo Jung
WJ
Lee
Gi Hong
GH
Choi
Jun Young
JY
Kim
Kyung Sik
KS
Kim
Jin Sub
JS
Choi
Byong Ro
BR
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors