Skip to main content
SpringerLink
Log in

Surgical Outcomes and Prognostic Factors for T2 Gallbladder Cancer Following Surgical Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer.

Methods

We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007.

Results

The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P < 0.001), extended surgery (P = 0.028), lymph node dissection (P = 0.024), non-infiltrative tumors (P = 0.001), well differentiation (P = 0.001), absence of lymphatic (P = 0.025), perineural (P = 0.001), and vascular (P = 0.025) invasion, absence of lymph node metastasis (P = 0.001), negative resection margin (P = 0.016), and stage (P = 0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis.

Conclusions

For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Chijiiwa K, Tanaka M. Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 1994;115:751–756

    CAS  PubMed  Google Scholar 

  2. Yamaguchi K, Chijiiwa K, Saiki S, Nishihara K, Takashima M, Kawakami K, Tanaka M. Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 1997;84:200–204

    Article  CAS  PubMed  Google Scholar 

  3. Chan SY, Poon RT, Lo CM, Ng KK, Fan ST. Management of carcinoma of the gallbladder: a single-institution experience in 16 years. J Surg Oncol 2008;97:156–164

    Article  PubMed  Google Scholar 

  4. Kai M, Chijiiwa K, Ohuchida J, Nagano M, Hiyoshi M, Kondo K. A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg 2007;11:1025–1032

    Article  PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. Chijiiwa K, Sumiyoshi K, Nakayama F. Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 1991;15:322–327

    Article  CAS  PubMed  Google Scholar 

  7. Puhalla H, Wild T, Bareck E, et al. Long-term follow-up of surgically treated gallbladder cancer patients. Eur J Surg Oncol 2002;28:857–863

    Article  CAS  PubMed  Google Scholar 

  8. Ito H, Matros E, Brooks DC, et al. Treatment outcomes associated with surgery for gallbladder cancer: a 20-year experience. J Gastrointest Surg 2004;8:183–190

    Article  PubMed  Google Scholar 

  9. Todoroki T, Kawamoto T, Takahashi H, Takada Y, Koike N, Otsuka M, Fukao K. Treatment of gallbladder cancer by radical resection. Br J Surg 1999;86:622–627

    Article  CAS  PubMed  Google Scholar 

  10. Shimada H, Endo I, Togo S, Nakano A, Izumi T, Nakagawara G. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 1997;79:892–899

    Article  CAS  PubMed  Google Scholar 

  11. Kwon AH, Imamura A, Kitade H, Kamiyama Y. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 2008;97:241–245

    Article  PubMed  Google Scholar 

  12. Wakai T, Shirai Y, Yokoyama N, Nagakura S, Watanabe H, Hatakeyama K. Early gallbladder carcinoma does not warrant radical resection. Br J Surg 2001;88:675–678

    Article  CAS  PubMed  Google Scholar 

  13. Behari A, Sikora SS, Wagholikar GD, Kumar A, Saxena R, Kapoor VK. Long-term survival after extended resections in patients with gallbladder cancer. J Am Coll Surg 2003;196:82–88

    Article  PubMed  Google Scholar 

  14. Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, Tanaka M. Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 2001; 192:600–607

    Article  CAS  PubMed  Google Scholar 

  15. Chijiiwa K, Yamaguchi K, Tanaka M. Clinicopathological differences between long-term and short-term postoperative survivors with advanced gallbladder carcinoma. World J Surg 1997;21:98–102

    Article  CAS  PubMed  Google Scholar 

  16. Yamamoto H, Hayakawa N, Kitagawa Y, Katohno Y, Sasaya T, Takara D, Nagino M, Nimura Y. Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 2005;12:391–398

    Article  PubMed  Google Scholar 

  17. Kang CM, Choi GH, Park SH, Kim KS, Choi JS, Lee WJ, Kim BR. Laparoscopic cholecystectomy only could be an appropriate treatment for selected clinical R0 gallbladder carcinoma. Surg Endosc 2007;21:1582–1587

    Article  CAS  PubMed  Google Scholar 

  18. Weiland ST, Mahvi DM, Niederhuber JE, Heisey DM, Chicks DS, Rikkers LF. Should suspected early gallbladder cancer be treated laparoscopically? J Gastrointest Surg 2002;6:50–56, discussion 56–57

    Article  PubMed  Google Scholar 

  19. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Manual, 6th ed. New York: Springer; 2002.

    Google Scholar 

  20. Shimada H, Endo I, Fujii Y, Kamiya N, Masunari H, Kunihiro O, Tanaka K, Misuta K, Togo S. Appraisal of surgical resection of gallbladder cancer with special reference to lymph node dissection. Langenbecks Arch Surg 2000;385:509–514

    Article  CAS  PubMed  Google Scholar 

  21. Sikora SS, Singh RK. Surgical strategies in patients with gallbladder cancer: nihilism to optimism. J Surg Oncol 2006;93:670–681

    Article  PubMed  Google Scholar 

  22. Yagi H, Shimazu M, Kawachi S, Tanabe M, Aiura K, Wakabayashi G, Ueda M, Nakamura Y, Kitajima M. Retrospective analysis of outcome in 63 gallbladder carcinoma patients after radical resection. J Hepatobiliary Pancreat Surg 2006;13:530–536

    Article  PubMed  Google Scholar 

  23. Kohya N, Miyazaki K. Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol 2008;97:498–502

    Article  PubMed  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. Fong Y, Heffeman N, Blumgart LH. Gallbladder carcinoma discovered during laparoscopic cholecystectomy: aggressive reresection is beneficial. Cancer 1998;83:423–427

    Article  CAS  PubMed  Google Scholar 

  26. 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

    Article  CAS  PubMed  Google Scholar 

  27. Foster JM, Hoshi H, Gibbs JF, Iyer R, Javle M, Chu Q, Kuvshinoff B. Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol 2007;14:833–840

    Article  PubMed  Google Scholar 

  28. Jensen EH, Abraham A, Habermann EB, Al-Refaie WB, Vickers SM, Virnig BA, Tuttle TM. A critical analysis of the surgical management of early-stage gallbladder cancer in the United States. J Gastrointest Surg 2009;13:722–727

    Article  PubMed  Google Scholar 

  29. Kokudo N, Makuuchi M, Natori T, Sakamoto Y, Yamamoto J, Seki M, Noie T, Sugawara Y, Imamura H, Asahara S, Ikari T. Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 2003;138:741–750

    Article  PubMed  Google Scholar 

  30. Sakamoto Y, Kosuge T, Shimada K, Sano T, Hibi T, Yamamoto J, Takayama T, Makuuchi M. Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. J Surg Oncol 2006;94:298–306

    Article  PubMed  Google Scholar 

  31. Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, Kato A, Miyazaki M. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2004;136:1012–1017

    Article  PubMed  Google Scholar 

  32. Araida T, Higuchi R, Hamano M, Kodera Y, Takeshita N, Ota T, Yoshikawa T, Yamamoto M, Takasaki K. Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey—a multicenter study. J Hepatobiliary Pancreat Surg 2009;16:204–215

    Article  PubMed  Google Scholar 

  33. Park JS, Yoon DS, Kim KS, Choi JS, Lee WJ, Chi HS, Kim BR. Actual recurrence patterns and risk factors influencing recurrence after curative resection with stage II gallbladder carcinoma. J Gastrointest Surg 2007;11:631–637

    Article  PubMed  Google Scholar 

  34. Aramaki M, Matsumoto T, Shibata K, Himeno Y, Yada K, Hirano S, Sasaki A, Kawano K, Kitano S. Factors influencing recurrence after surgical treatment for T2 gallbladder carcinoma. Hepatogastroenterology 2004;51:1609–1611

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80, Gurodong, Guro-gu, Seoul, Korea

    Sae Byeol Choi, Hyung Joon Han, Wan Bae Kim & Sang Yong Choi

  2. Korea University College of Medicine, Korea University Anam Hospital, Anam-Dong 5-Ga, Seongbuk-Gu, Seoul, Korea

    Chung Yun Kim, Sung Ock Suh & Young Chul Kim

  3. Korea University College of Medicine, Korea University Ansan Hospital, Gojan 1-Dong, Danwon-Gu, Ansan-Si, Gyeonggi-Do, Seoul, Korea

    Tae-Jin Song

Authors
  1. Sae Byeol Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyung Joon Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chung Yun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wan Bae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tae-Jin Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sung Ock Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Young Chul Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sang Yong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Yong Choi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Choi, S.B., Han, H.J., Kim, C.Y. et al. Surgical Outcomes and Prognostic Factors for T2 Gallbladder Cancer Following Surgical Resection. J Gastrointest Surg 14, 668–678 (2010). https://doi.org/10.1007/s11605-009-1132-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-009-1132-z

Keywords

Search

Navigation