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

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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.

Original languageEnglish
Pages (from-to)1035-1041
Number of pages7
JournalWorld journal of surgery
Volume33
Issue number5
DOIs
Publication statusPublished - May 1 2009

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Gallbladder Neoplasms
Lymphatic Vessels
Incidental Findings
Survival
Laparoscopic Cholecystectomy
Cholecystectomy
Survival Analysis
Reoperation
Retrospective Studies
Lymph Nodes
Neoplasm Metastasis
Phenotype

All Science Journal Classification (ASJC) codes

  • Surgery

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Lymphatic invasion : An important prognostic factor for stages T1b-T3 gallbladder cancer and an indication for additional radical resection of incidental gallbladder cancer. / Shibata, Kohei; Uchida, Hiroki; Iwaki, Kentaro; Kai, Seiichiro; Ohta, Masayuki; Kitano, Seigo.

In: World journal of surgery, Vol. 33, No. 5, 01.05.2009, p. 1035-1041.

Research output: Contribution to journalArticle

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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.",
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T2 - An important prognostic factor for stages T1b-T3 gallbladder cancer and an indication for additional radical resection of incidental gallbladder cancer

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AU - Kai, Seiichiro

AU - Ohta, Masayuki

AU - Kitano, Seigo

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N2 - 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.

AB - 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.

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