Rhodin Kristen E, Goins Stacy, Kramer Ryan, Eckhoff Austin M, Herbert Garth, Shah Kevin N, Allen Peter J, Nussbaum Daniel P, Blazer Dan G, Zani Sabino, Lidsky Michael E
Department of Surgery, Duke University, 2301 Erwin Rd, Durham, NC 27710, USA.
Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA.
HPB (Oxford). 2024 Apr;26(4):594-602. doi: 10.1016/j.hpb.2024.01.012. Epub 2024 Jan 24.
Radical cholecystectomy is recommended for T1B and greater gallbladder cancer, however, there are conflicting reports on the utility of extended resection for T1B disease. Herein, we characterize outcomes following simple and radical cholecystectomy for pathologic stage T1B gallbladder cancer.
The National Cancer Database (NCDB) was queried for patients with pathologic T1B gallbladder cancer diagnosed from 2004 to 2018. Patients were stratified by surgical management. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods.
Altogether, 950 patients were identified with pathologic T1B gallbladder cancer: 187 (19.7 %) receiving simple and 763 (80.3 %) radical cholecystectomy. Median OS was 89.5 (95 % CI 62.5-137) and 91.4 (95 % CI 75.9-112) months for simple and radical cholecystectomy, respectively (log-rank p = 0.55). Receipt of simple cholecystectomy was not associated with greater hazard of mortality compared to radical cholecystectomy (HR 1.23, 95 % CI 0.95-1.59, p = 0.12).
In this analysis, we report comparable outcomes with simple cholecystectomy among patients with pathologic T1B gallbladder cancer. These findings suggest that highly selected patients, such as those with R0 resection and imaging at low risk for residual disease and/or nodal metastasis, may not benefit from extended resection; however, radical cholecystectomy remains standard of care until prospective validation can be achieved.
对于T1B期及以上的胆囊癌，推荐行根治性胆囊切除术，然而，关于T1B期疾病扩大切除术的效用存在相互矛盾的报道。在此，我们描述了病理分期为T1B期胆囊癌行单纯胆囊切除术和根治性胆囊切除术后的结局。
查询国家癌症数据库（NCDB）中2004年至2018年诊断为病理T1B期胆囊癌的患者。患者按手术治疗方式分层。采用Kaplan-Meier法和多变量Cox比例风险法比较总生存期（OS）。
共识别出950例病理T1B期胆囊癌患者：187例（19.7%）接受单纯胆囊切除术，763例（80.3%）接受根治性胆囊切除术。单纯胆囊切除术和根治性胆囊切除术的中位OS分别为89.5个月（95%CI 62.5-137）和91.4个月（95%CI 75.9-112）（对数秩检验p=0.55）。与根治性胆囊切除术相比，接受单纯胆囊切除术与更高的死亡风险无关（HR 1.23，95%CI 0.95-1.59，p=0.12）。
在本分析中，我们报告了病理T1B期胆囊癌患者单纯胆囊切除术的结局相似。这些发现表明，经过严格筛选的患者，如那些R0切除且影像学显示残留疾病和/或淋巴结转移风险低的患者，可能无法从扩大切除术中获益；然而，在获得前瞻性验证之前，根治性胆囊切除术仍是标准治疗方法。
