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Abstract
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.
Figures and Tables
Fig. 2
Disease-free survival of 13 patients with T2 gallbladder cancer after simple cholecystectomy.
References
1. D'Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009. 16:806–816.
2. Yagi H, Shimazu M, Kawachi S, Tanabe M, Aiura K, Wakabayashi G, et al. Retrospective analysis of outcome in 63 gallbladder carcinoma patients after radical resection. J Hepatobiliary Pancreat Surg. 2006. 13:530–536.
3. Toyonaga T, Chijiiwa K, Nakano K, Noshiro H, Yamaguchi K, Sada M, et al. Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg. 2003. 27:266–271.
4. Box JC, Edge SB. Laparoscopic cholecystectomy and unsuspected gallbladder carcinoma. Semin Surg Oncol. 1999. 16:327–331.
5. Copher JC, Rogers JJ, Dalton ML. Trocar-site metastasis following laparoscopic cholecystectomy for unsuspected carcinoma of the gallbladder. Case report and review of the literature. Surg Endosc. 1995. 9:348–350.
6. Ouchi K, Mikuni J, Kakugawa Y. Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. J Hepatobiliary Pancreat Surg. 2002. 9:256–260.
7. Pearlstone DB, Curley SA, Feig BW. The management of gallbladder cancer: before, during, and after laparoscopic cholecystectomy. Semin Laparosc Surg. 1998. 5:121–128.
8. Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H. Radical surgery for gallbladder carcinoma. Long-term results. Ann Surg. 1992. 216:565–568.
9. Shoup M, Fong Y. Surgical indications and extent of resection in gallbladder cancer. Surg Oncol Clin N Am. 2002. 11:985–994.
10. Principe A, Del Gaudio M, Ercolani G, Golfieri R, Cucchetti A, Pinna AD. Radical surgery for gallbladder carcinoma: possibilities of survival. Hepatogastroenterology. 2006. 53:660–664.
11. Wise PE, Shi YY, Washington MK, Chapman WC, Wright JK, Sharp KW, et al. Radical resection improves survival for patients with pT2 gallbladder carcinoma. Am Surg. 2001. 67:1041–1047.
12. Shirai Y, Yoshida K, Tsukada K, Muto T. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg. 1992. 215:326–331.
13. Benoist S, Panis Y, Fagniez PL. Long-term results after curative resection for carcinoma of the gallbladder. French University Association for Surgical Research. Am J Surg. 1998. 175:118–122.
14. Hu JB, Sun XN, Xu J, He C. Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography. World J Gastroenterol. 2008. 14:6428–6431.
15. Aoki Y, Shimura H, Li H, Mizumoto K, Date K, Tanaka M. A model of port-site metastases of gallbladder cancer: the influence of peritoneal injury and its repair on abdominal wall metastases. Surgery. 1999. 125:553–559.
16. Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA. Carcinoma of the gallbladder. Does radical resection improve outcome? Arch Surg. 1990. 125:237–241.
17. Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg. 1996. 224:639–646.
18. Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M. Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg. 1991. 15:337–343.
19. Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000. 232:557–569.
20. de Aretxabala X, Roa I, Burgos L, Araya JC, Fonseca L, Wistuba I, et al. Gallbladder cancer in Chile. A report on 54 potentially resectable tumors. Cancer. 1992. 69:60–65.
21. Aramaki M, Matsumoto T, Shibata K, Himeno Y, Yada K, Hirano S, et al. Factors influencing recurrence after surgical treatment for T2 gallbladder carcinoma. Hepatogastroenterology. 2004. 51:1609–1611.
22. Wakai T, Shirai Y, Yokoyama N, Ajioka Y, Watanabe H, Hatakeyama K. Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol. 2003. 10:447–454.
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