Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2022; 28(31): 4431-4441
Published online Aug 21, 2022. doi: 10.3748/wjg.v28.i31.4431
Simple cholecystectomy is an adequate treatment for grade I T1bN0M0 gallbladder carcinoma: Evidence from 528 patients
Jun Shao, Hong-Cheng Lu, Lin-Quan Wu, Jun Lei, Rong-Fa Yuan, Jiang-Hua Shao
Jun Shao, Hong-Cheng Lu, Lin-Quan Wu, Jun Lei, Rong-Fa Yuan, Jiang-Hua Shao, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Shao J and Lu HC contributed equally to this work; Shao J, Shao JH, and Lu HC were involved in study concept and design, drafting of the manuscript and study supervision; Wu LQ contributed to collect data; Lei J and Yuan RF contributed to analyze the data; Shao JH, Shao J, and Lu HC critically revise the manuscript; all authors have read and approve the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81773126, No. 81560475, and No. 82160486.
Institutional review board statement: The study was reviewed and approved by the Second Affiliated Hospital of Nanchang University Institutional Review Board, No. 74.
Informed consent statement: Patients from the Surveillance, Epidemiology, and End Results (SEER) database consented to participate in any scientific research worldwide.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The datasets used or analyzed in this study are available from the corresponding author at shao5022@163.com. Patients from the Surveillance, Epidemiology, and End Results (SEER) database consented to participate in any scientific research worldwide.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiang-Hua Shao, MD, PhD, Chief Doctor, Full Professor, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang 330006, Jiangxi Province, China. shao5022@163.com
Received: April 21, 2022
Peer-review started: April 21, 2022
First decision: May 30, 2022
Revised: June 12, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 21, 2022
Abstract
BACKGROUND

T1b gallbladder carcinoma (GBC) is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver. However, controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection.

AIM

To explore the optimal surgical approach in patients with T1b gallbladder cancer of different pathological grades.

METHODS

Patients with T1bN0M0 GBC who underwent surgical treatment between 2000 and 2017 were included in the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier method and log-rank test were used to analyze the overall survival (OS) and disease-specific survival (DSS) of patients with T1b GBC of different pathological grades. Cox regression analysis was used to identify independent predictors of mortality and explore the selection of surgical methods in patients with T1b GBC of different pathological grades and their relationship with prognosis.

RESULTS

Of the 528 patients diagnosed with T1bN0M0 GBC, 346 underwent simple cholecystectomy (SC) (65.5%), 131 underwent SC with lymph node resection (SC + LN) (24.8%), and 51 underwent radical cholecystectomy (RC) (9.7%). Without considering the pathological grade, both the OS (P < 0.001) and DSS (P = 0.003) of T1b GBC patients who underwent SC (10-year OS: 27.8%, 10-year DSS: 55.1%) alone were significantly lower than those of patients who underwent SC + LN (10-year OS: 35.5%, 10-year DSS: 66.3%) or RC (10-year OS: 50.3%, 10-year DSS: 75.9%). Analysis of T1b GBC according to pathological classification revealed no significant difference in OS and DSS between different types of procedures in patients with grade I T1b GBC. In patients with grade II T1b GBC, obvious survival improvement was observed in the OS (P = 0.002) and DSS (P = 0.039) of those who underwent SC + LN (10-year OS: 34.6%, 10-year DSS: 61.3%) or RC (10-year OS: 50.5%, 10-year DSS: 78.8%) compared with those who received SC (10-year OS: 28.1%, 10-year DSS: 58.3%). Among patients with grade III or IV T1b GBC, SC + LN (10-year OS: 48.5%, 10-year DSS: 72.2%), and RC (10-year OS: 80%, 10-year DSS: 80%) benefited OS (P = 0.005) and DSS (P = 0.009) far more than SC (10-year OS: 20.1%, 10-year DSS: 38.1%) alone.

CONCLUSION

Simple cholecystectomy may be an adequate treatment for grade I T1b GBC, whereas more extensive surgery is optimal for grades II-IV T1b GBC.

Keywords: Gallbladder carcinoma, Tumor-node-metastasis, Survival analysis, Tumor grade, Surgical treatment

Core Tip: T1b gallbladder carcinoma (GBC) is defined as a tumor that invades the perimuscular connective tissue without extension beyond the serosa or into the liver. However, controversy still exists over whether patients with T1b GBC should undergo cholecystectomy alone or radical GBC resection. In this study, we included patients with different histological grades of T1b GBC and compared the survival time of patients who underwent simple cholecystectomy, cholecystectomy with lymph node resection, or radical cholecystectomy to explore the optimal surgical approach for these patients.