Prognoses of patients who underwent a two-step radical operation or simple operation with T2/3 incidental gallbladder cancer : a single center experience

Abstract

A radical operation including partial resection of liver, bile duct, and lymph nodes is recommended for patients with advanced stages of incidental gallbladder cancer. We attempted to clarify whether radical operation confers survival benefit compared with simple cholecystectomy and find factors that could accurately predict prognoses.From January 2004 to November 2009, 39 patients who were incidentally diagnosed with stage T2 or T3 gallbladder cancer were included in this retrospective study. The patients were divided into two groups. One group underwent a two-step operation that included simple cholecystectomy followed by radical cholecystectomy (n=18), and the other group underwent only simple operation (n=21). The median overall survival (OS) time of all patients was 44.1 months, and median disease-free survival (DFS) time was 16.0 months. 3-year DFS rates and 3-year OS rates of the radical operation group and simple operation groups were not significantly different. Among simple operation group, the patients underwent simple cholecystectomy and regional lymph node dissection had higher DFS and OS than other groups. 3-year DFS rates of simple cholecystectomy, simple cholecystectomy with regional lymph node dissection, and radical operation were 14%, 63%, and 38% (p=0.078), and 3-year OS rates were 14%, 77%, and 49% (p=0.028), respectively. There were no significant differences among DFS or OS of the groups with or without any adjuvant treatment. Only for the 7 patients underwent simple cholecystectomy without regional lymph node dissection, the patients received adjuvant treatment showed better DFS and OS than the patients without adjuvant treatment. 2-year DFS rate was 25% vs. 0% (p=0.157), and 2-year OS rate was 75% vs. 0% (p=0.034). Female gender (relative risk [RR] 2.213, p=0.017), poorly differentiated histology (RR 3.844, p=0.011), T3 stage rather than T2 stage (RR 2.890, p=0.028), and positive lymph-node invasion (RR 2.794, p=0.050) were predictive of disease recurrence. Poor differentiation (RR 3.803, p=0.01) and elevated preoperative carcinoembryonic antigen (CEA) concentration (RR 6.185, p=0.002) were poor prognostic factors for OS.Simple cholecystectomy with regional lymph node dissection might result in a therapeutic outcome comparable to that obtained by radical operation. The development of effective postoperative chemotherapies following simple operation will help achieve this goal. Well-designed prospective studies using new adjuvant chemotherapeutic regimens are necessary.