Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer
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Background/Aims: Extended cholecystectomy is generally recommended for patients with T2 gallbladder cancer. However, few studies have assessed the extent of resection relative to T2 gallbladder tumor location. This study analyzed the effects of surgical methods and tumor location on survival outcomes and tumor recurrence in patients with T2 gallbladder cancer. Methods: Clinicopathological characteristics, extent of resection, survival rates, and recurrence patterns were retrospectively analyzed in 88 patients with pathologically confirmed T2 gallbladder cancer. Results: The 5-year disease-free survival rate was 65.0%. Multivariate analysis showed that lymph node metastasis was the only independent risk factor for poor 5-year disease-free survival rate. Survival outcomes were not associated with tumor location. Survival tended to be better in patients who underwent extended cholecystectomy than in those who underwent simple cholecystectomy. Recurrence rate was not affected by surgical method or tumor location. Systemic recurrence was more frequent than local recurrence without distant recurrence. Gallbladder bed recurrence and liver recurrence were relatively rare, occurring only in patients with liver side tumors. Conclusions: Extended cholecystectomy is the most appropriate treatment for T2 gallbladder cancer. However, simple cholecystectomy with regional lymph node dissection may be appropriate for patients with serosal side tumors.
Abstract
Background/Aims: Extended cholecystectomy is generally recommended for patients with T2 gallbladder cancer. However, few studies have assessed the extent of resection relative to T2 gallbladder tumor location. This study analyzed the effects of surgical methods and tumor location on survival outcomes and tumor recurrence in patients with T2 gallbladder cancer. Methods: Clinicopathological characteristics, extent of resection, survival rates, and recurrence patterns were retrospectively analyzed in 88 patients with pathologically confirmed T2 gallbladder cancer. Results: The 5-year disease-free survival rate was 65.0%. Multivariate analysis showed that lymph node metastasis was the only independent risk factor for poor 5-year disease-free survival rate. Survival outcomes were not associated with tumor location. Survival tended to be better in patients who underwent extended cholecystectomy than in those who underwent simple cholecystectomy. Recurrence rate was not affected by surgical method or tumor location. Systemic recurrence was more frequent than local recurrence without distant recurrence. Gallbladder bed recurrence and liver recurrence were relatively rare, occurring only in patients with liver side tumors. Conclusions: Extended cholecystectomy is the most appropriate treatment for T2 gallbladder cancer. However, simple cholecystectomy with regional lymph node dissection may be appropriate for patients with serosal side tumors.
참고문헌 (36)
- Carriaga MT, "Liver, gallbladder, extrahepatic bile ducts, and pancreas", Cancer, 75(1), pp.171~190 (1995)
- Henson DE, "Carcinoma of the gallbladder: histologic types, stage of disease, grade, and survival rates", Cancer, 70, pp.1493~1497 (1992)
- Edge SB, "AJCC cancer staging manual" (2010), Springer
- Benson AB 3rd, "NCCN clinical practice guidelines in oncology: hepatobiliary cancers", J Natl Compr Canc Netw, 7, pp.350~391 (2009)
- Bartlett DL, "Long-term results after resection for gallbladder cancer: implications for staging and management", Ann Surg, 224, pp.639~646 (1996)
- Kai M, "A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma", J Gastrointest Surg, 11, pp.1025~1032 (2007)
- Chijiiwa K, "Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer", J Am Coll Surg, 192, pp.600~607 (2001)
- Shimada H, "Appraisal of surgical resection of gallbladder cancer with special reference to lymph node dissection", Langenbecks Arch Surg, 385, pp.509~514 (2000)
- Wakai T, "Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma", Ann Surg Oncol, 10, pp.447~454 (2003)
- Kokudo N, "Strategies for surgical treatment of gallbladder carcinoma based on information available before resection", Arch Surg, 138, pp.741~750 (2003)
- Choi SB, "Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection", J Gastrointest Surg, 14, pp.668~678 (2010)
- Fahim RB, "Carcinoma of the gallbladder: a study of its modes of spread", Ann Surg, 156, pp.114~124 (1962)
- Endo I, "Microscopic liver metastasis: prognostic factor for patients with pT2 gallbladder carcinoma", World J Surg, 28, pp.692~696 (2004)
- Sasaki R, "Clinicopathological study of depth of subserosal invasion in patients with pT2 gallbladder carcinoma", J Surg Oncol, 92, pp.83~88 (2005)
- Kang CM, "Does “clinical” R0 have validity in the choice of simple cholecystectomy for gallbladder carcinoma?", J Gastrointest Surg, 11, pp.1309~1316 (2007)
- Shirai Y, "“Extended” radical cholecystectomy for gallbladder cancer: long-term outcomes, indications and limitations", World J Gastroenterol, 18, pp.4736~4743 (2012)
- de Aretxabala X, "Gallbladder cancer: an analysis of a series of 139 patients with invasion restricted to the subserosal layer", J Gastrointest Surg, 10, pp.186~192 (2006)
- Foster JM, "Gallbladder cancer: defining the indications for primary radical resection and radical re-resection", Ann Surg Oncol, 14, pp.833~840 (2007)
- Wright BE, "Management of T2 gallbladder cancer: are practice patterns consistent with national recommendations?", Am J Surg, 194, pp.820~825 (2007)
- Mayo SC, "National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis", J Gastrointest Surg, 14, pp.1578~1591 (2010)
- Wakai T, "Radical second resection provides survival benefit for patients with T2 gallbladder carcinoma first discovered after laparoscopic cholecystectomy", World J Surg, 26, pp.867~871 (2002)
- Kim DH, "Role of cholecystectomy and lymph node dissection in patients with T2 gallbladder cancer", World J Surg, 37, pp.2635~2640 (2013)
- Goetze TO, "The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry", Surg Endosc, 26, pp.1382~1389 (2012)
- Goetze TO, "Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German registry", Ann Surg, 247, pp.104~108 (2008)
- Lammert F, "S3-guidelines for diagnosis and treatment of gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract", Z Gastroenterol, 45, pp.971~1001 (2007)
- Kondo S, "Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment", J Hepatobiliary Pancreat Surg, 15, pp.41~54 (2008)
- 이승은, "Practical Guidelines for the Surgical Treatment of Gallbladder Cancer", Journal of Korean Medical Science, 29(10), pp.1333~1340 (2014), 대한의학회
- Shirai Y, "Radical surgery for gallbladder carcinoma: long-term results", Ann Surg, 216, pp.565~568 (1992)
- Yamaguchi K, "Subclinical gallbladder carcinoma", Am J Surg, 163, pp.382~386 (1992)
- Matsumoto Y, "Surgical treatment of primary carcinoma of the gallbladder based on the histologic analysis of 48 surgical specimens", Am J Surg, 163, pp.239~245 (1992)
- de Aretxabala XA, "Curative resection in potentially resectable tumours of the gallbladder", Eur J Surg, 163, pp.419~426 (1997)
- Oertli D, "Primary carcinoma of the gallbladder: operative experience during a 16 year period", Eur J Surg, 159, pp.415~420 (1993)
- Shirai Y, "Inapparent carcinoma of the gallbladder: an appraisal of a radical second operation after simple cholecystectomy", Ann Surg, 215, pp.326~331 (1992)
- Fong Y, "Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention", Ann Surg, 232, pp.557~569 (2000)
- Shindoh J, "Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study", Ann Surg, 261, pp.733~739 (2015)
- Cho JY, "Laparoscopic approach for suspected early-stage gallbladder carcinoma", Arch Surg, 145, pp.128~133 (2010)