title: What is the better choice for T1b gallbladder cancer: simple versus extended cholecystectomy.
abstract: BACKGROUND
  There is debate over whether T1b gallbladder cancer (GBC) should be treated by simple cholecystectomy (SC) or by extended cholecystectomy (EC). The aim of this study is to compare and analyze the results of these two procedures.
  
  
  METHODS
  The archived medical records of 805 patients with GBC who had undergone surgical resection in Asan Medical Center, or were referred from other hospitals after undergoing surgery, between 1997 and 2010 were retrospectively reviewed. Of these, 85 patients were diagnosed with pathologic stage T1b (muscular layer) GBC. By using propensity scoring, the EC group and the SC group were matched in the proportion of 1:2; so, 54 patients were enrolled in this study.
  
  
  RESULTS
  Among the 54 pathologic stage T1b cancer patients, SC was performed in 36 (66.7 %) and EC in 18 (33.4 %). The mean operation time and hospital stay after surgery of the SC group was significantly shorter than in the EC group (83.2 vs. 356.4 min, 7.8 vs. 15.2 days; both p = 0.000). Disease recurrence was noted in four cases (11.1 %), all in the SC group; 50 % of recurred patients experienced recurrence at the lymph node. There was no significant intergroup difference in the 5-year survival rate (5-YSR) (88.8 % for SC vs. 93.3 % for EC, p = 0.521).
  
  
  CONCLUSIONS
  In this study, for stage T1b GBC, both EC and SC offered similar cure rates. However, recurrence is associated with SC and inadequate lymph node dissection (LND). Therefore, EC including regional LND may be justified and preferred because of the possibility of lymph node metastasis and the accurate assessment of stage (LN status), except that the patients have a high risk of operation.
authors.affiliation: Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea, challenge-yoon@hanmail.net.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Yoon
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Song Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Hwang
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Lee
authors.forename: Kwang Min
authors.initials: KM
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods*; D003138:Common Bile Duct Neoplasms / Q000556:secondary*; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012189:Retrospective Studies; D015996:Survival Rate