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 ShibataEmail author
  • Hiroki Uchida
  • Kentaro Iwaki
  • Seiichiro Kai
  • Masayuki Ohta
  • Seigo Kitano



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).


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.


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.


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


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.



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.


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Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Kohei Shibata
    • 1
    Email author
  • 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

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