Prognostic Effect of Liver Resection in Extended Cholecystectomy for T2 Gallbladder Cancer Revisited

Abstract

Objective: This study aimed to evaluate the effect of liver resection on the prognosis of T2 gallbladder cancer (GBC). Background: Although extended cholecystectomy [lymph node dissection (LND) + liver resection] is recommended for T2 GBC, recent studies have shown that liver resection does not improve survival outcomes relative to LND alone. Methods: Patients with pT2 GBC who underwent extended cholecystectomy as an initial procedure and did not reoperation after cholecystectomy at 3 tertiary referral hospitals between January 2010 and December 2020 were analyzed. Extended cholecystectomy was defined as either LND with liver resection (LND+L group) or LND only (LND group). We conducted 2:1 propensity score matching to compare the survival outcomes of the groups. Results: Of the 197 patients enrolled, 100 patients from the LND+L group and 50 from the LND group were successfully matched. The LND+L group experienced greater estimated blood loss (P<0.001) and a longer postoperative hospital stay (P=0.047). There was no significant difference in the 5-year disease-free survival (DFS) of the 2 groups (82.7% vs 77.9%, respectively, P=0.376). A subgroup analysis showed that the 5-year DFS was similar in the 2 groups in both T substages (T2a: 77.8% vs 81.8%, respectively, P=0.988; T2b: 88.1% vs 71.5%, respectively, P=0.196). In a multivariable analysis, lymph node metastasis [hazard ratio (HR) 4.80, P=0.006] and perineural invasion (HR 2.61, P=0.047) were independent risk factors for DFS; liver resection was not a prognostic factor (HR 0.68, P=0.381). Conclusions: Extended cholecystectomy including LND without liver resection may be a reasonable treatment option for selected T2 GBC patients.