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What is the Better Choice for T1b Gallbladder Cancer: Simple Versus Extended Cholecystectomy

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Abstract

Background

There is debate over whether T1b gallbladder cancer (GBC) should be treated by simple cholecystectomy (SC) or by extended cholecystectomy (EC). The aim of this study is to compare and analyze the results of these two procedures.

Patients and methods

The archived medical records of 805 patients with GBC who had undergone surgical resection in Asan Medical Center, or were referred from other hospitals after undergoing surgery, between 1997 and 2010 were retrospectively reviewed. Of these, 85 patients were diagnosed with pathologic stage T1b (muscular layer) GBC. By using propensity scoring, the EC group and the SC group were matched in the proportion of 1:2; so, 54 patients were enrolled in this study.

Results

Among the 54 pathologic stage T1b cancer patients, SC was performed in 36 (66.7 %) and EC in 18 (33.4 %). The mean operation time and hospital stay after surgery of the SC group was significantly shorter than in the EC group (83.2 vs. 356.4 min, 7.8 vs. 15.2 days; both p = 0.000). Disease recurrence was noted in four cases (11.1 %), all in the SC group; 50 % of recurred patients experienced recurrence at the lymph node. There was no significant intergroup difference in the 5-year survival rate (5-YSR) (88.8 % for SC vs. 93.3 % for EC, p = 0.521).

Conclusions

In this study, for stage T1b GBC, both EC and SC offered similar cure rates. However, recurrence is associated with SC and inadequate lymph node dissection (LND). Therefore, EC including regional LND may be justified and preferred because of the possibility of lymph node metastasis and the accurate assessment of stage (LN status), except that the patients have a high risk of operation.

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Acknowledgments

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea

    Jong Hee Yoon

  2. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Young Joo Lee, Song Cheol Kim, Jae Hoon Lee, Ki Byung Song, Jeong Woo Lee, Dong Joo Lee & Kwang Min Park

  3. Department of Surgery, Hallym University Medical Center, Chuncheon, South Korea

    Ji Woong Hwang

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  1. Jong Hee Yoon
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  2. Young Joo Lee
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  4. Jae Hoon Lee
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  5. Ki Byung Song
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  6. Ji Woong Hwang
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  7. Jeong Woo Lee
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  8. Dong Joo Lee
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  9. Kwang Min Park
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Correspondence to Jong Hee Yoon.

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Yoon, J.H., Lee, Y.J., Kim, S.C. et al. What is the Better Choice for T1b Gallbladder Cancer: Simple Versus Extended Cholecystectomy. World J Surg 38, 3222–3227 (2014). https://doi.org/10.1007/s00268-014-2713-x

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