Should the Extrahepatic Bile Duct be Resected for T2 Gallbladder Cancer?

ABSTRACT

PURPOSE: The prognosis of advanced gallbladder cancer remains unfortunate. Yet, the prognostic factors and the efficacy of extrahepatic bile duct resection remain unclear. The adequacy for extrahepatic bile duct resection for T2 gallbladder cancer, according to the characteristics of either the clinicopathological factors or the prognostic factors, was evaluated. METHODS: One hundred and one patients with gallbladder cancer underwent surgical resection at Yeungnam University Medical Center (YUMC) between January 2001 and July 2008. A retrospective analysis was conducted on 26 patients with pathologic stage T2. RESULTS: 7 of the 26 patients with T2 disease (26.9%) had lymph node metastasis. Of the 7 patients with lymph node metastasis, 3 patients underwent radical cholecystectomy (RC), and 4 patients underwent radical cholecystectomy combined with extrahepatic bile duct resection (RC+BDR). The 1-year and 3-year survival rate of patients that underwent RC was 66.7% and 0% and patients that underwent RC+BDR was 50.0% and 0%, respectively (P=0.433). Even with microscopic vascular invasion or perineural invasion, RC+BDR did not provide any survival advantage compared with RC in T2 gallbladder cancer. Prognostic factors for patients with T2 gallbladder cancer was total bilirubin level, lymph node metastasis, differentiation of tumor, microscopic vascular invasion and perineural invasion. CONCLUSION: For patients with T2 gallbladder cancer, RC is recommended, even with the presence of lymph node metastasis, microvascular invasion or perineural invasion. Resection of the extrahepatic bile duct is indicated for patients with T2 gallbladder cancer with involvement of the cystic duct or invasion of the hepatoduodenal ligament.