Advertisement

World Journal of Surgery

, Volume 33, Issue 5, pp 1035–1041 | Cite as

Lymphatic Invasion: An Important Prognostic Factor for Stages T1b–T3 Gallbladder Cancer and an Indication for Additional Radical Resection of Incidental Gallbladder Cancer

  • Kohei Shibata
  • Hiroki Uchida
  • Kentaro Iwaki
  • Seiichiro Kai
  • Masayuki Ohta
  • Seigo Kitano
Article

Abstract

Background

Laparoscopic cholecystectomy is being performed with increasing frequency worldwide. This has led to more frequent discovery of incidental gallbladder cancer (IGBC) and in turn to the need for an independent prognostic factor for stages T1b–T3 gallbladder cancer so that is can be determined clinically which cases of IGBC are indicated for additional radical resection (ARR).

Methods

A retrospective study was conducted that included 72 patients who underwent macroscopically curative surgical resection (R0, R1) at our center for stages T1b–T3 GBC. Survival analysis was performed, and the usefulness of ARR was analyzed in 15 patients with IGBC.

Results

Univariate analysis of disease-specific survival showed stage T3, histologic grade II–IV, lymphatic invasion, vessel invasion, perineural invasion, lymph node metastasis, and a positive resection margin to be factors indicative of poor prognosis. Independent predictors of poor disease-specific survival were stage T3 (hazard ratio, 2.33 [95% CI, 1.10–4.95]), lymphatic invasion (5.97 [1.29–27.6]), and a positive resection margin (3.17 [1.51–6.63]). Among the 15 IGBC patients, 4 of 5 patients without lymphatic invasion were cured, 2 of whom underwent cholecystectomy alone; 4 of 10 patients with lymphatic invasion did not undergo ARR, and the cancer recurred in all 4 patients; the other 6 patients underwent ARR, and 4 of them were cured by reoperation.

Conclusions

Lymphatic invasion well reflects the malignant phenotype of stages T1b–T3 GBC. We advocate ARR for IGBC patients with lymphatic invasion.

Keywords

Laparoscopic Cholecystectomy Cystic Duct Gallbladder Cancer Perineural Invasion Lymphatic Invasion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors are grateful to Dr. K. Kashima (pathologist certified by the Japanese Society of Pathology) for excellent pathologic diagnosis, and to Ms. F. Kawamura and Ms. F. Hayashi for excellent technical assistance.

References

  1. 1.
    Chen AY, Daley J, Pappas TN et al (1998) Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes. Ann Surg 227:12–24PubMedCrossRefGoogle Scholar
  2. 2.
    Zacks SL, Sandler RS, Rutledge R et al (2002) A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 97:334–340PubMedCrossRefGoogle Scholar
  3. 3.
    Steinert R, Nestler G, Sagynaliev E et al (2006) Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 93:682–689PubMedCrossRefGoogle Scholar
  4. 4.
    Shih SP, Schulick RD, Cameron JL et al (2007) Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 245:893–901PubMedCrossRefGoogle Scholar
  5. 5.
    Cucinotta E, Lorenzini C, Melita G et al (2005) Incidental gall bladder carcinoma: does the surgical approach influence the outcome? Aust N Z J Surg 75:795–798CrossRefGoogle Scholar
  6. 6.
    Varshney S, Butturini G, Gupta R (2002) Incidental carcinoma of the gallbladder. Eur J Surg Oncol 28:4–10PubMedCrossRefGoogle Scholar
  7. 7.
    Yildirim E, Celen O, Gulben K et al (2005) The surgical management of incidental gallbladder carcinoma. Eur J Surg Oncol 31:45–52PubMedCrossRefGoogle Scholar
  8. 8.
    Shirai Y, Yoshida K, Tsukada K et al (1992) Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215:326–331PubMedCrossRefGoogle Scholar
  9. 9.
    Foster JM, Hoshi H, Gibbs JF et al (2007) Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol 14:833–840PubMedCrossRefGoogle Scholar
  10. 10.
    Kang CM, Lee WJ, Choi GH et al (2007) Does “clinical” R0 have validity in the choice of simple cholecystectomy for gallbladder carcinoma? J Gastrointest Surg 11:1309–1316PubMedCrossRefGoogle Scholar
  11. 11.
    Kang CM, Choi GH, Park SH et al (2007) Laparoscopic cholecystectomy only could be an appropriate treatment for selected clinical R0 gallbladder carcinoma. Surg Endosc 21:1582–1587PubMedCrossRefGoogle Scholar
  12. 12.
    Aramaki M, Matsumoto T, Shibata K et al (2004) Factors influencing recurrence after surgical treatment for T2 gallbladder carcinoma. Hepatogastroenterology 51:1609–1611PubMedGoogle Scholar
  13. 13.
    Chijiiwa K, Nakano K, Ueda J et al (2001) Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 192:600–607PubMedCrossRefGoogle Scholar
  14. 14.
    Renyi-Vamos F, Jellinek H (1957) Lymphatic system of the gallbladder and its pathological significance. Magy Tud 8:107–110PubMedGoogle Scholar
  15. 15.
    Ito M, Mishima Y, Sato T (1991) An anatomical study of the lymphatic drainage of the gallbladder. Surg Radiol Anat 13:89–104PubMedCrossRefGoogle Scholar
  16. 16.
    Terazawa T, Miyake H, Kurahashi M et al (2004) Direct lymphatic spreading route into the liver from the gallbladder: an animal experiment using pig. J Med Invest 51:210–217PubMedCrossRefGoogle Scholar
  17. 17.
    Otero JC, Proske A, Vallilengua C et al (2006) Gallbladder cancer: surgical results after cholecystectomy in 25 patients with lamina propria invasion and 26 patients with muscular layer invasion. J Hepatobiliary Pancreat Surg 13:562–566PubMedCrossRefGoogle Scholar
  18. 18.
    Yoshida T, Matsumoto T, Sasaki A et al (2000) Laparoscopic cholecystectomy in the treatment of patients with gallbladder cancer. J Am Coll Surg 191:158–163PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Kohei Shibata
    • 1
  • Hiroki Uchida
    • 1
  • Kentaro Iwaki
    • 1
  • Seiichiro Kai
    • 1
  • Masayuki Ohta
    • 1
  • Seigo Kitano
    • 1
  1. 1.Department of Surgery IOita University Faculty of MedicineOitaJapan

Personalised recommendations