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KMID : 0870420130170030113
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2013 Volume.17 No. 3 p.113 ~ p.117
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Prognosis of patients with pT1b/T2 gallbladder carcinoma who have undergone laparoscopic cholecystectomy as an initial operation
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Park Ye-Jong
Hwang Shin
Kim Ki-Hun
Lee Young-Joo
Ahn Chul-Soo
Moon Deok-Bog
Park Kwang-Min
Ha Tae-Yong
Song Gi-Won
Jung Dong-Hwan
Park Gil-Chun
Lee Jae-Hun
Lee Sung-Gyu
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Abstract
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Backgrounds/Aims: Laparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gall-bladder diseases. There has been a small proportion of gallbladder cancer (GBC) which was incidentally found in the gallbladder specimen, and LC has been tried in some patients with faintly suspected GBC. This study intended to analyze the prognosis of patients with pT1b/T2 GBC who have undergone LC and the outcome of extended re-operation.
Methods: After analyzing the institutional profiles of 500 GBC patients who have undergone surgical re-section, we selected 64 patients who underwent LC initially from January 1996 to December 2008 and whose gall-bladder pathology was confined to pT1b or pT2 lesions. Of them, 34 patients (53.1%) underwent extended reoperation. Their medical records were reviewed retrospectively.
Results: In the LC only group (n=30), mean age of the 16 pT1 patients was 65.7±12.5 years and mean age of the 14 pT2 patients was 66.7±10.1 years. In the reoperation group (n=34), mean age of the 8 pT1b patients was 52.6±9.9 years and in 26 pT2 patients, mean age was 59.2±7.9 years. The reoperation group showed a younger patient age pattern than the LC only group (p=0.001). The types of reopera-tion were liver resection with lymph node (LN) dissection in 17, bile duct resection with LN dissection in 2, and hep-atectomy and bile duct resection with LN dissection in 15. In the LC only group, the 5-year survival rate (5-YSR) was 70.3% in pT1b and 43.2% in pT2. In the reoperation group, 5-YSR was 62.5% in pT1b (n=8) and 59.5% in pT2 (n=26). A survival comparison between the two groups showed no significant survival gain in pT1 patients (p=0.69) and in pT2 patients (p=0.14). In our whole database analysis, 5-YSR of pT1bNx lesions was 70% after cholecystectomy and 78% after extended cholecystectomy. Lymph node metastasis was identified in 11% of pT1b lesions. For pT2N0 lesions, overall 5-YSR was 62% after R0 resection, showing no survival difference between primary extended surgery and LC-redo operation (p=0.45).
Conclusions: The survival gain of reoperation was not evident in pT1b lesions. In contrast, some noticeable but not statistically significant survival difference was observed in pT2 lesions. Thus, reopera-tion for pT1b/T2 GBC following LC is indicated for individualized reasons, especially in patients with pT1b lesions. Old age was one of the important factors in deciding not to reoperate.
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KEYWORD
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Gallbladder carcinoma, Laparoscopic cholecystectomy, Extended cholecystectomy, Recurrence, Reoperation
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