Surgical treatment of gallbladder cancer: An eight-year experience in a single center

Table 5 Important literature and guidelines

Ref.	Country	Year	Remarks	Comments in each guideline
[43]	Germany	2013	Prognosis of incidental GBC was not influenced by the primary access technique.	Conventional open surgery is recommended for suspicious GBCs.
[44]	Japan	2003	Preoperative information indicated strategies for surgical treatment of GBCs.	Conventional open surgery is recommended for suspicious GBCs.
[45]	Japan	1996	Outcome of radical surgery for GBCs was evaluated according to the TNM classification.	Intentional LN dissection and prophylactic EHBD resection are considered for potential pathological invasions.
[46]	Japan	2004	Strong consideration should be given to intentional LN dissection and EHBD resection.	Intentional LN dissection and prophylactic EHBD resection are considered for potential pathological invasions.
[47]	Japan	2013	Hepatectomy of segments 4a and 5 was not superior to extended cholecystectomy in patients with pathological T2.	The EHBD resection does not improve the prognosis in patients with T2N0.
[48]	Korea	2013	Radical resection (R0 surgery) including EHBD resection should be considered in patients with T2 and T3 (A single-centre retrospective study).	The EHBD resection does not improve the prognosis in patients with T2N0.
[49]	Japan	2014	Surgery might not be indicated for patients with advanced invasion to the EHBD and visible paraaortic LN metastasis (A single-centre retrospective study).	The EHBD resection does not improve the prognosis in patients with T2N0.
[50]	Korea	2015	Two-stage surgery was highly recommended for patients with pathological T2 (A single-centre retrospective study).	The EHBD resection does not improve the prognosis in patients with T2N0.
[51]	Japan	2015	Combined treatment of intentional LN dissection and prophylactic EHBD resection had no survival impact for patients without the EHBD invasion (A single-centre retrospective study).	The EHBD resection does not improve the prognosis in patients with T2N0.
[52]	Japan	2012	Hepatectomy procedures (e.g., systematic, segmental and partial resections) did not significantly affect surgical outcomes	Radical resection (R0 surgery) is the most important prognostic factor
[53]	United States	2008	GBC was commonly diagnosed incidentally, and two-stage surgery revealed a high incidence of residual disease.	Overall prognosis is poor.
[54]	United States	2004	Surgeries were not routinely indicated for advanced GBCs with jaundice.	Jaundice is common in patients with advanced GBC.
[55]	France	2011	EHBD resection increased postoperative morbidity but did not improve survival.	Partial hepatectomy without EHBD resection indicates incidental GBC.
[56]	Korea	2011	Extended cholecystectomy was not advantageous over simple cholecystectomy for patients with T1b.	Simple cholecystectomy is adequate therapy for patients with T1a.
[57]	United States	2007	Radical resection for patients with T2 and T3 resulted in a significant survival advantage compared with simple cholecystectomy.	Advantages of radical resection including extended hepatectomy for incidental GBC and patients with T1b are controversial.
[58]	Canada	2008	Intentional LN dissection and EHBD resection may have stage-specific effects on survival.	Radical resection improves survivals in patients with T1b and T2 (not in patients with T3).
[59]	Korea	2008	Cholecystectomy with intentional LN dissection without EHBD resection was recommended for patients with T1b.	Advantages of radical resection including extended hepatectomy for incidental GBC and patients with T3b are controversial.
[60]	United States	2009	Radical resection had survival advantage for patients with T1b and T2.	Radical resection improves survival in patients with T1b and T2 (not in patients with T3).
[61]	United States	2011	Extended surgery including intentional LN dissection improved survival for incidental GBC	Aggressive surgeries including hepatectomy, LN dissection and EHBD resection are indicated for patients with T3, localized hepatic invasion and regional LN metastases.
[62]	Japan	2012	Extended cholecystectomy was adequate for patients with T2, and more aggressive surgeries were indicated for patients with T3, localized hepatic invasion and regional LN metastases.	Aggressive surgeries including hepatectomy, LN dissection and EHBD resection are indicated for patients with T3, localized hepatic invasion and regional LN metastases.
[63]	United States	2009	Major hepatectomy and EHBD resection were significantly associated with perioperative morbidity, and were not mandatory in all cases.	Independent prognostic factors associated with survival are T factor, N factor, pathological poor differentiation and EHBD involvement.
[64]	United States	2007	EHBD resection did not yield a greater count of LNs. Over one-third had residual disease in the EHBD at two-stage surgery.	During two-stage surgery, EHBD resection is indicated for negative cystic duct margins.
[65]	United States	2000	Radical resection can provide long-term survival, even for large tumors with extensive liver invasion.	Aggressive surgeries including hepatectomy, LN dissection and EHBD resection are indicated for patients with T3, localized hepatic invasion and regional LN metastases.
[66]	United States	2007	Incidental GBCs during laparoscopic cholecystectomy did not indicate immediate conversion to open surgery, and these patients should be referred to a tertiary care center for further surgery.	There was no difference in surgical deficit between immediate resection at the initial hospital and delayed resection at tertiary care center.
[67]	France	2011	Jaundice was a poor prognostic factor, but radical resection had survival benefit especially in highly selected patients with N0.	Radical resection improves survival in patients with N0.
[20]	Japan	2011	Patients with advanced GBCs were candidates for EHBD resection, if radical resection (R0) was achievable.	Radical resection improves survival in patients with EHBD invasion.
[68]	India	2016	Chemoradiotherapy in unresectable GBCs resulted in the resectability, and subsequent radical surgery (R0) had survival benefit. LN regression could serve as a predictor of response to radiochemotherapy.	Chemoradiotherapy in unresectable GBCs may result in the resectability, and conversion surgery (R0) has survival benefit.
[69]	United States	2017	Radical surgeries after favorable responses to neoadjuvant chemotherapies were associated with long-term survival in selected patients.	Chemoradiotherapy in unresectable GBCs may result in the resectability, and conversion surgery (R0) has survival benefit.
[70]	United States	2011	Pathological assessment of at least 6 LNs was important.	Patients with incidental GBC and T2 associated with residual tumor, and should undergo surgery to reflect the adverse outcome.
[71]	Canada	2012	Adjuvant radiochemotherapy had the greatest benefit in patients with positive LNs and R1 disease.	Adjuvant radiochemotherapy is beneficial.

EHBD: Extrahepatic bile duct; GBC: Gallbladder cancer; LN: Lymph node.