Surgical Strategy for T1 and T2 Incidental Gallbladder Cancer: Nationwide Multicenter Survey in South Korea

Introduction: Because curative resection is the mainstay of GB cancer (GBC) treatment, additional second resection aimed to the removal of residual disease is considered to the incidentally detected GBC. However, because till now, no guidelines have been established, in the absence of prospective clinical trials, the core principles of re-resection for histologically-proven GBC found during surgery or postoperative histopathology are basically identical to the surgical strategy of GBC that is suspected preoperatively. This multicenter study investigated clinical features and clinical outcome of incidentally detected T1 and T2 GBC with the aim of determining the best surgical strategy. Method: A nationwide multicenter study from 2000 to 2004 was performed in which 17 university hospitals in Korea participated. Total 668 patients were enrolled and 40 % of the patients were incidental GBC (N=267) and 60 % of patients were suspected GBC (N=401). The clinicopathologic findings and long-term follow-up results were analyzed. Result: Male to female ratio was 1 to 1.2. Mean age was 63 years and mean follow-up period was 55 months. For T1 GBC, there was no significant difference in 5-year disease specific survival rate (5YSR) between simple cholecystectomy (SC) group and extended cholecystectomy (EC) group. For T2 GBC, EC group showed significantly better 5YSR than SC group (64.1% vs. 53.1%, p=0.045). Systemic recurrence was more common than locoregional recurrence (78.5% VS. 21.5%). Lymph node metastasis was significant poor prognostic factor in a multivariate analysis. Conclusion: EC including wedge resection of GB bed should be recommended for T2 incidental GBC. Because systemic recurrence was more common and recurrence occurred more frequently in patients with LN metastasis, postoperative adjuvant therapy should be considered especially for the patients with lymph node metastasis.