Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, Zhejiang Province, China; Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. Electronic address: https://twitter.com/MingyuChen6.
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Surgery. 2021 Jun;169(6):1304-1311. doi: 10.1016/j.surg.2020.12.039. Epub 2021 Feb 5.
Liver resection is recommended for T2 gallbladder cancer, but the optimal hepatectomy strategy remains controversial. We aimed to assess the safety and effectiveness of segment IVb and V resection versus wedge resection in patients with T2 gallbladder cancer.
This is a retrospective multicenter propensity score-matched study in China. Overall survival, disease-free survival, perioperative complications, and hospital length of stay were used to evaluate safety and effectiveness.
There are a total of 512 patients. 112 of 117 patients undergoing segment IVb and V resection were matched to 112 patients undergoing wedge resection. After matching, segment IVb and V resection demonstrated no statistical difference in overall survival (hazard ratio, 0.970 [0.639-1.474]; P = .886), but significance in disease-free survival (hazard ratio, 0.708 [0.506-0.991]; P = .040). Patients with incidental gallbladder cancer (hazard ratio, 0.390 [0.180-0.846]; P = .019), stage T2b (hazard ratio, 0.515 [0.302-0.878]; P = .016), and negative lymph nodes status (hazard ratio, 0.627 [0.406-0.991]; P = .043) were associated with improved disease-free survival after segment IVb and V resection, but not in wedge resection. However, perioperative complications occurred more frequently after segment IVb and V resection (28.5% vs 9.1%, P < .001) along with the longer hospital length of stay (17.3 vs 10.2 days, P < .001). Notably, patients with jaundice (odds ratio, 4.053 [1.361-12.23]; P = .013), undergoing laparoscopic resection (odds ratio, 2.387 [1.059-4.484]; P = .028) or surgeon performing per the first 10 segment IVb and V resections (odds ratio, 2.697 [1.035-6.998]; P = .041), were the independent risk factors for perioperative complications in the segment IVb and V resection group.
T2 gallbladder cancer patients undergoing segment IVb and V resection rather than wedge resection have an improved disease-free survival, especially for incidental gallbladder cancer or hepatic-sided (T2b) gallbladder cancer. However, high rates of perioperative complications and longer hospital length of stay after segment IVb and V resection indicated that surgeons must rely on their own surgical skills and the patient profile to decide the optimal hepatectomy strategy.
肝切除术被推荐用于 T2 期胆囊癌，但最佳肝切除术策略仍存在争议。我们旨在评估 T2 期胆囊癌患者行 IVb 段和 V 段切除术与楔形切除术的安全性和有效性。
这是一项在中国进行的回顾性多中心倾向评分匹配研究。总生存、无病生存、围手术期并发症和住院时间用于评估安全性和有效性。
共有 512 例患者。117 例行 IVb 段和 V 段切除术的患者中有 112 例与 112 例行楔形切除术的患者相匹配。匹配后，IVb 段和 V 段切除术在总生存方面无统计学差异（风险比，0.970[0.639-1.474]；P=0.886），但在无病生存方面有显著差异（风险比，0.708[0.506-0.991]；P=0.040）。偶然发现的胆囊癌（风险比，0.390[0.180-0.846]；P=0.019）、T2b 期（风险比，0.515[0.302-0.878]；P=0.016）和淋巴结阴性状态（风险比，0.627[0.406-0.991]；P=0.043）与 IVb 段和 V 段切除术后无病生存改善相关，但在楔形切除术组中则没有。然而，IVb 段和 V 段切除术后围手术期并发症更常见（28.5%比 9.1%，P<0.001），且住院时间更长（17.3 天比 10.2 天，P<0.001）。值得注意的是，有黄疸（优势比，4.053[1.361-12.23]；P=0.013）、行腹腔镜切除术（优势比，2.387[1.059-4.484]；P=0.028）或由前 10 例 IVb 段和 V 段切除术的外科医生进行手术（优势比，2.697[1.035-6.998]；P=0.041）的患者是 IVb 段和 V 段切除术组围手术期并发症的独立危险因素。
与楔形切除术相比，T2 期胆囊癌患者行 IVb 段和 V 段切除术可获得更好的无病生存，尤其是对于偶然发现的胆囊癌或肝侧（T2b）胆囊癌。然而，IVb 段和 V 段切除术后高发生率的围手术期并发症和更长的住院时间表明，外科医生必须根据自身的手术技能和患者情况来决定最佳的肝切除术策略。
