Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer.
OBJECTIVE
To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis (TNM) staging system.


METHODS
A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system (AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy (or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm non-neoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. Kaplan-Meier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was considered statistically significant.


RESULTS
Patients were grouped based on the new 7(th) edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage I, 25 cases of stage II, 21 cases of stage IIIA, 21 cases of stage IIIB, 24 cases of stage IVA, 43 cases of stage IVB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and I disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy (P = 0.826). The prognosis of stage II patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage III patients, radical cholecystectomy was significantly superior to other surgical options (P < 0.05). For stage IVA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage IVB, patients who underwent palliative resection significantly outlived those with non-surgical treatment (P < 0.01) CONCLUSION: For stages 0 and I patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages II and III patients.
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Xiao-Dong
XD
He
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Jing-Jing
JJ
Li
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Wei
W
Liu
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Qiang
Q
Qu
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Tao
T
Hong
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Xie-Qun
XQ
Xu
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Bing-Lu
BL
Li
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Ying
Y
Wang
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Hai-Tao
HT
Zhao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004322:Drainage; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
Gallbladder cancer; Prognosis; Radical cholecystectomy; Simple cholecystectomy; Tumor-node-metastasis staging