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Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China

Authors
  • Ren, Tai
  • Li, Yong-Sheng
  • Dang, Xue-Yi
  • Li, Yang
  • Shao, Zi-Yu
  • Bao, Run-Fa
  • Shu, Yi-Jun
  • Wang, Xu-An
  • Wu, Wen-Guang
  • Wu, Xiang-Song
  • Li, Mao-Lan
  • Cao, Hong
  • Wang, Kun-Hua
  • Cai, Hong-Yu
  • Jin, Chong
  • Jin, Hui-Han
  • Yang, Bo
  • Jiang, Xiao-Qing
  • Gu, Jian-Feng
  • Cui, Yun-Fu
  • And 17 more
Type
Published Article
Journal
World Journal of Gastrointestinal Surgery
Publisher
Baishideng Publishing Group Inc
Publication Date
Feb 27, 2021
Volume
13
Issue
2
Pages
176–186
Identifiers
DOI: 10.4240/wjgs.v13.i2.176
PMID: 33643537
PMCID: PMC7898187
Source
PubMed Central
Keywords
Disciplines
  • Observational Study
License
Green

Abstract

BACKGROUND Whether regional lymphadenectomy (RL) should be routinely performed in patients with T1b gallbladder cancer (GBC) remains a subject of debate. AIM To investigate whether RL can improve the prognosis of patients with T1b GBC. METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China. The log-rank test and Cox proportional hazards model were used to compare the overall survival (OS) of patients who underwent cholecystectomy (Ch) + RL and those who underwent Ch only. To investigate whether combined hepatectomy (Hep) improved OS in T1b patients, we studied patients who underwent Ch + RL to compare the OS of patients who underwent combined Hep and patients who did not. RESULTS Of the 121 patients (aged 61.9 ± 10.1 years), 77 (63.6%) underwent Ch + RL, and 44 (36.4%) underwent Ch only. Seven (9.1%) patients in the Ch + RL group had lymph node metastasis. The 5-year OS rate was significantly higher in the Ch + RL group than in the Ch group (76.3% vs 56.8%, P = 0.036). Multivariate analysis showed that Ch + RL was significantly associated with improved OS (hazard ratio: 0.51; 95% confidence interval: 0.26-0.99). Among the 77 patients who underwent Ch + RL, no survival improvement was found in patients who underwent combined Hep (5-year OS rate: 79.5% for combined Hep and 76.1% for no Hep; P = 0.50). CONCLUSION T1b GBC patients who underwent Ch + RL had a better prognosis than those who underwent Ch. Hep + Ch showed no improvement in prognosis in T1b GBC patients. Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines, RL was only performed in 63.6% of T1b GBC patients. Routine Ch + RL should be advised in T1b GBC.

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