Node positivity in T1b gallbladder cancer: A high volume centre experience |
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| Institution: | 1. Department of Surgical Sciences, Department of Colorectal Surgery, Uppsala University, 752 36, Uppsala, Sweden;2. Department of Surgical Sciences, Department of Colorectal Surgery, Uppsala University Hospital, S-751 85, Uppsala, Sweden;1. Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, UK;2. Queen''s University Belfast, University Road, Belfast, Northern Ireland, UK;1. Peter MacCallum Cancer Centre, Division of Surgical Oncology, Australia;2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia;3. Peter MacCallum Cancer Centre, Division of Medical Oncology, Australia;4. Peter MacCallum Cancer Centre, Division of Cancer Imaging, Australia;5. Peter MacCallum Cancer Centre, Division of Anatomical Pathology, Australia;1. Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom;2. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;3. Department of Surgery & Cancer, Imperial College London, London, United Kingdom;4. Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden;5. Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle-Upon-Tyne, United Kingdom;6. School of Medical Education, Newcastle University, Newcastle Upon Tyne, Tyne and Wear, United Kingdom;7. Department of Clinical Oncology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom;8. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA;9. Edward-Elmhurst Health, Department of Surgical Oncology, Naperville, IL, USA;1. Department of Medicine and Surgery, University of Parma, Parma, Italy;2. Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Gynecology and Obstetrics, Roma, Italy;3. Department of Gynecologic Oncology, Gemelli Molise SpA, Campobasso, Italy;4. Department of Gynecologic Oncology, University of Palermo, Palermo, Italy;5. Department of Medicine and Health Science “V.Tiberio” Università degli Studi del Molise, Campobasso, Italy |
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| Abstract: | IntroductionIdentification of early stage gallbladder cancer (GBC) is difficult with simple cholecystectomy being considered curative for T1a GBC but T1b requires radical cholecystectomy due to chances of lymph node metastasis. However there is no consensus regarding the optimal treatment strategy for T1b disease.MethodologyA retrospective review of a prospectively maintained database of GBC patients operated at our institute from March 2010 to March 2021 was conducted. Only patients with proven gallbladder adenocarcinoma on final histopathology report were included.ResultsA total of 1245 patients of suspected GBC who underwent surgery during this period with 76 patients of T1b stage were analysed. We divided the group into a node positive cohort (n = 16, 9 received neoadjuvant treatment due to uptake in periportal nodes and 7 patients were pN1) and a node negative cohort (n = 60). The median nodal harvest was 8 nodes (2–24 nodes). Considering the radiological and pathological parameters, the rate of lymph node positivity was 21% (16/76). The overall major morbidity was 5.2% and there was no mortality. After a median follow up of 47.5 months, 3-year OS and DFS of the node negative and positive cohort was 96.7%, 91.7% and 75% and 62.5% (p = 0.058). The node positive cohort had 43% recurrences whereas the node negative cohort had 8.3% with all recurrences limited to periportal lymph nodes, distant nodes or liver metastasis.ConclusionNodal positivity for T1b gall bladder cancer ranges around 21% and radical surgery with complete peri –portal lymphadenectomy should be considered as standard of care. |
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| Keywords: | Gallbladder carcinoma Node positive T1b |
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