# A trial of sparing the liver resection in peritoneal-side (T2a) gallbladder cancer

Source: https://onco.cc/ideas/idea-gbc-t2a-spare-liver-resection-trial/  
OnCo record `idea-gbc-t2a-spare-liver-resection-trial` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Muscle-invading gallbladder tumours on the free side of the organ recur in the liver far less often than those against it. Two meta-analyses found the liver resection helped only the liver-side group, so a randomised trial could test dropping it for the free side.

## Summary

Shindoh (2015) showed liver recurrence of 3 percent for peritoneal-side against 23 percent for hepatic-side T2 tumours; Kang's meta-analysis (1,789 patients) found no survival difference between extended and simple cholecystectomy in T2a (odds ratio 0.802) and Khan's (2,345 patients) found liver resection improved survival only in T2b. Lymphadenectomy would be retained because T2a nodal metastasis is still 27 percent. Reproducible assignment of side on pathology is the practical obstacle and would need a central review protocol.

## Fields

- Kind: Idea
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Hypothesis: In T2a gallbladder cancer, cholecystectomy with portal lymphadenectomy but without liver bed resection is non-inferior to extended cholecystectomy for five-year recurrence-free survival.
- Rationale: The liver bed is the target of the resection and the liver is rarely the site of recurrence in T2a; nodes remain a risk and are retained in the experimental arm.
- Proposed test: Randomised non-inferiority trial with central pathology confirmation of side, stratified by incidental versus suspected presentation; recurrence-free survival primary, liver-specific recurrence and morbidity secondary.
- Maturity: early-clinical
- Actor: research

## Sources

- Kang et al.: prognostic significance of tumour location in T2 gallbladder cancer, meta-analysis (J Clin Med 2021): https://europepmc.org/article/MED/34362101
- Khan et al.: tumour location and liver resection in T2 gallbladder cancer, meta-analysis (Updates Surg 2021): https://europepmc.org/article/MED/34426958

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/)
- terms: [De-escalation, escalation and response-adapted therapy](https://onco.cc/terms/de-escalation/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/), [T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side)](https://onco.cc/terms/t2a-versus-t2b/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- key papers: [Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis](https://onco.cc/key-papers/paper-kang-t2-gallbladder-cancer-location-meta-analysis-jcm-2021/), [Surgical Strategy for T2 Gallbladder Cancer According to Tumor Location](https://onco.cc/key-papers/paper-lee-t2-gallbladder-cancer-surgical-strategy-aso-2015/), [Tumor location and concurrent liver resection, impact survival in T2 gallbladder cancer: a meta-analysis of the literature](https://onco.cc/key-papers/paper-khan-t2-gallbladder-cancer-liver-resection-meta-analysis-updates-surg-2021/), [Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study](https://onco.cc/key-papers/paper-shindoh-t2-gallbladder-cancer-tumour-location-ann-surg-2015/)
- roadmaps: [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/)

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