Optimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study
Across 14 specialist centres in Korea, Japan, Chile and the United States, people with a gallbladder cancer that had just reached the muscle layer did equally well whether or not they had a second, bigger operation: about 95 in 100 were alive and free of the disease at five years either way.
Overview
Retrospective study of 272 patients with T1b gallbladder cancer resected at 14 centres with specialised hepatobiliary surgeons and pathologists; 237 qualified for analysis (90 men, 147 women). Simple cholecystectomy was performed in 116 (48.9 percent) and extended cholecystectomy in 121 (51.1 percent). Five-year disease-specific survival was 94.6 percent overall and did not differ between simple and extended cholecystectomy (93.7 versus 95.5 percent, p=0.496), in America (82.3 versus 100 percent, p=0.249) or Asia (98.6 versus 95.2 percent, p=0.690), nor by lymph node metastasis (p=0.688) or tumour location (p=0.474).
- Five-year disease-specific survival 93.7 percent after simple cholecystectomy vs 95.5 percent after extended cholecystectomy (p=0.496) in 237 T1b patients.
- No difference by region, nodal status or tumour location.
The strongest data against routine re-resection for T1b tumours, which guidelines still recommend. A prospective study or registry with standardised pathology is the missing step; the authors' own conclusion is that extended cholecystectomy is not needed for T1b.
- Retrospective; patients offered simple cholecystectomy may have had favourable features.
- Pathological standardisation of T1b across centres is itself difficult, as the authors note.
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