The Efficacy of Simple Cholecystectomy among Patients with T2 Gallbladder Cancer

PURPOSE: Stage-related treatment has been recommended for gallbladder cancer (GBC). When patients with T2 tumors undergo an extended cholecystectomy, the 5-year survival rates have been reported to be 64~100%. But when patients with T2 tumors undergo simple cholecystectomy, the 5-year survival rates have been reported to be only 20~40%. The question may rise as to which patients benefit from simple cholecystectomy among patients with T2 GBC. We investigated the survivals and the facts leading to death or recurrence after simple cholecystectomy for T2 GBC. METHODS: Between Mar. 2001 and Dec. 2007, 13 patients had refused second radical operation for T2 GBC incidentally discovered after simple cholecystectomy. Survival analyses were evaluated by clinopathological factors. RESULTS: The 1-, 3- and 4-year overall survival rates were 84.6%, 76.2% and 38.1% and 1- and 3-year disease-free survival rates were 69.2%, 51.3%. The factors affected survival rates were low serum albumin titer and R1 resection (Lymph node metastasis or cystic duct involvement in microscopic finding) (P<0.05). CONCLUSION: Simple cholecystectomy is not a curative method of T2 GBC, because it reveals lower 5-year survival rates compared to those of extended cholecystectomy or radical surgery. But in the case when the patient refuses reoperation or it is difficult to undergo reoperation because of severe underlying disease, simple cholecystectomy with normal albumin titer or the absence of lymph node metastasis and absence of cystic duct involvement in microscopic findings may help the long-term survivals after simple cholecystectomy.

Analysis of Clinical Outcome and Prognostic Factors in Patients with Gallbladder Cancer

PURPOSE: The aim of the present study was to determine proper treatment strategies to improve the outcome of patients with gallbladder cancer by an analysis of multiple factors affecting tumor recurrence and patient survival. METHODS: Between January 1991 and April 2006, surgery with curative intent was performed on 120 patients with gallbladder cancer. Of 120 cases, 35 patients had findings that precluded any further intervention, and the remaining 85 patients underwent curative resections that included a simple cholecystectomy in 43 cases, a radical cholecystectomy in 32 cases and an extended cholecystectomy in 10 cases. Clinicopathogical data was analyzed. RESULTS: The presence of jaundice at presentation, gross morphology of the tumor, tumor cell differentiation, presence of a lymph node metastasis, lymphatic invasion and direct invasion to other contagious organ(s) and achievement of a tumor-free resection margin were associated with survival. For stage I gallbladder cancer, in only T2 lesions, patients that undergone a simple cholecystectomy had double the rate of recurrence as compared to patients that undergone a radical cholecystectomy (12.5% versus 26.1%; p = .119). For stage II gallbladder cancer, survival and disease-free survival for patients that undergone a radical cholecystectomy were improved as compared to patients that undergone a simple cholecystectomy; survival and disease-free survival was poor for patients that had undergone an extended cholecystectomy, especially in patients that had bile duct invasion (4/5; 80%). For stage III/IV gallbladder cancer, all patients (n = 6) underwent an extended cholecystectomy and half of the patients survived longer than one year. CONCLUSION: Radical cholecystectomy could be a standard procedure for gallbladder cancer in addition to just stage II cancer. An aggressive approach including resecting contagious organ(s) in locally advanced gallbladder cancer could provide a survival benefit without an increase in complications.