Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4620-4626
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4620
Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Hai-Tao Zhao
Xiao-Dong He, Jing-Jing Li, Wei Liu, Qiang Qu, Tao Hong, Xie-Qun Xu, Bing-Lu Li, Ying Wang, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Hai-Tao Zhao, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: He XD and Li JJ contributed equally to this work; He XD and Zhao HT made substantial contributions to study conception and design; Li JJ, Liu W, Qu Q, Hong T, Xu XQ, Li BL and Wang Y participated in acquisition of data, analysis and drafting the article; and Zhao HT gave final approval of the version.
Supported by Capital Special Research Project for Health Development (2014-2-4012), State Natural Research Funding, No. 81372578; National Natural Science Foundation of China, No. 30970623 and No. 91229120; International Science and Technology Cooperation Projects, No. 2010DFA31840 and No. 2010DFB33720; and Program for New Century Excellent Talents in University, No. NCET-11-0288.
Informed consent: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest: We declare that we have no conflicts of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hai-Tao Zhao, MD, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. zhaoht@pumch.cn
Telephone: +86-10-69156042 Fax: +86-10-69156043
Received: October 3, 2014
Peer-review started: October 4, 2014
First decision: October 29, 2014
Revised: November 11, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: April 21, 2015
Abstract

AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis (TNM) staging system.

METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system (AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy (or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm non-neoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient’s circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. Kaplan-Meier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was considered statistically significant.

RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage I, 25 cases of stage II, 21 cases of stage IIIA, 21 cases of stage IIIB, 24 cases of stage IVA, 43 cases of stage IVB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and I disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy (P = 0.826). The prognosis of stage II patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage III patients, radical cholecystectomy was significantly superior to other surgical options (P < 0.05). For stage IVA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage IVB, patients who underwent palliative resection significantly outlived those with non-surgical treatment (P < 0.01)

CONCLUSION: For stages 0 and I patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages II and III patients.

Keywords: Gallbladder cancer, Simple cholecystectomy, Tumor-node-metastasis staging, Radical cholecystectomy, Prognosis

Core tip: Surgical resection is still the only cure for gallbladder cancer. Choice of surgery procedure based upon disease stages remains an important topic. This study showed that simple cholecystectomy would be the best choice for stages 0 and I gallbladder cancer (GBC) patients; stages II and III patients should actively seek for radical cholecystectomy (or extended radical resection surgery); and palliative treatment should be the major method for patients with stage IV GBC, and careful evaluation was necessary before applying any more aggressive surgical procedure.