Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg. 2023 Dec 1;278(6):985-993. doi: 10.1097/SLA.0000000000005908. Epub 2023 May 23.
This study aimed to evaluate the effect of liver resection on the prognosis of T2 gallbladder cancer (GBC).
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.
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.
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).
Extended cholecystectomy including LND without liver resection may be a reasonable treatment option for selected T2 GBC patients.
本研究旨在评估肝切除术对 T2 胆囊癌（GBC）患者预后的影响。
尽管推荐对 T2 GBC 患者行扩大胆囊切除术[淋巴结清扫术（LND）+肝切除术]，但最近的研究表明，与单独 LND 相比，肝切除术并不能改善生存结局。
本研究分析了 2010 年 1 月至 2020 年 12 月在 3 家三级转诊医院接受初始扩大胆囊切除术且术后未再次手术的 pT2 GBC 患者。扩大胆囊切除术定义为 LND 联合肝切除术（LND+L 组）或单纯 LND（LND 组）。我们进行了 2:1 的倾向评分匹配，以比较两组的生存结局。
在纳入的 197 例患者中，LND+L 组的 100 例患者和 LND 组的 50 例患者成功匹配。LND+L 组术中失血量较多（ P <0.001），术后住院时间较长（ P =0.047）。两组患者的 5 年无病生存率（DFS）无显著差异（分别为 82.7%和 77.9%， P =0.376）。亚组分析显示，在 2 个 T 分期亚组中，两组患者的 5 年 DFS 相似（T2a：分别为 77.8%和 81.8%， P =0.988；T2b：分别为 88.1%和 71.5%， P =0.196）。多变量分析显示，淋巴结转移（HR 4.80， P =0.006）和神经周围侵犯（HR 2.61， P =0.047）是 DFS 的独立危险因素；肝切除术不是预后因素（HR 0.68， P =0.381）。
对于选择的 T2 GBC 患者，不包括肝切除术的扩大胆囊切除术联合 LND 可能是一种合理的治疗选择。
