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Lee, Kim, Chang, Kang, Lee, and Han: Radical Reresection for T2 Gallbladder Cancer Patients Diagnosed following Laparoscopic Cholecystectomy
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 78(6): 398-404.

Published online: 7 June 2010

DOI: https://doi.org/10.4174/jkss.2010.78.6.398

Radical Reresection for T2 Gallbladder Cancer Patients Diagnosed following Laparoscopic Cholecystectomy

Byung Seok Lee, M.D., Dong Hee Kim, M.D., Yeon Soo Chang, M.D., Jae Hee Kang, M.D., Tae Seok Lee, M.D., Jun Gil Han, M.D.

Department of Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.

Corresponding author (kdh2109@eulji.ac.kr)

Received 4 January 2010       Accepted 17 February 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Despite advances in imaging techniques, laparoscopic cholecystectomy (LC) gives many advantages to some patients with suspected gallbladder cancer. The aim of this study was to investigate clinicopathological features and to analyze the risk factors of recurrence after radical reresection for T2 gallbladder cancer patients diagnosed following LC.

Methods

From January 2002 to December 2009, the data of 21 consecutive patients for radical reresection for T2 gallbladder cancer were reviewed, retrospectively. The significance of the variables for recurrence was examined by the Kaplan-Meier method and log-rank test followed by multivariate analyses using Cox's proportional hazard model.

Results

Of the 21 patients studied, 11 were men and 10 were women. Lymph node metastasis was present in 7 patients (33.4%). The 5-year survival rate and disease-free survival rate in those patients were 75.3% and 67.9%, respectively. In the univariate analysis, the male gender (P=0.0047), poorly differentiated tumor (P=0.0169), presence of lymph node metastasis (P=0.0012), presence of lymphovascular invasion (P=0.0259) and presence of perineural invasion (P=0.0096) were significant factors related to recurrence after radical reresection. In the multivariate analysis, the presence of lymph node metastasis was an independently significant factor (5-year disease free survival rate, 20.9% vs. 83.8% in the absence of lymph node metastasis; P=0.015).

Conclusion

For patients with T2 gallbladder carcinoma diagnosed following LC, radical reresection is highly recommended and the presence of lymph node metastasis is an unfavorable prognostic factor that calls for additional treatment after radical surgery.

Keywords: Laparoscopic cholecystectomy, Gallbladder carcinoma, Prognostic factor, Radical reresection

Figures and Tables

Fig. 1
(A) Overall survival rates in patients with T2 gallbladder carcinoma undergone radical reresection following laparoscopic cholecystectomy. (B) Disease free survival rates in patients with T2 gallbladder carcinoma undergone radical reresection following laparoscopic cholecystectomy.
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Fig. 2
Disease free survival rates in patients with T2 gallbladder carcinoma undergone radical reresection following laparoscopic cholecystectomy according to presence of lymph node metastasis. P<0.05 by the log-rank test.
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Table 1
Clinical characterisitics of T2 gallbladder cancer patients having undergone radical reresection
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*LC = laparoscopic cholecystectomy; †LWR = liver wedge resection; ‡LND = lymph node dissection; §BDR = bile duct resection.

Table 2
Pathologic characteristics of T2 gallbladder cancer patients having undergone radical reresection
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*Others = papillary carcinoma (3 cases), mucinous carcinoma (1 case), undifferentiated carcinoma (1 case).

Table 3
Clinical outcomes of 5 recurrent cases in 21 patients having undergone radical reresection for T2 gallbladder carcinoma
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*NED = no evidence of disease; †DOD = dead of disease; ‡LWR = liver wedge resection; §LND = lymph node dissection; ∥BDR = bile duct resection; IP = intraperitoneal; **RFA = radio frequency ablation.

Table 4
Significant prognostic factors for disease free survival of patients with T2 gallbladder carcinoma in univariate and multivariate analyses
jkss-78-398-i004

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