Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2021; 13(2): 176-186
Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.176
Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China
Tai Ren, Yong-Sheng Li, Xue-Yi Dang, Yang Li, Zi-Yu Shao, Run-Fa Bao, Yi-Jun Shu, Xu-An Wang, Wen-Guang Wu, Xiang-Song Wu, Mao-Lan Li, Hong Cao, Kun-Hua Wang, Hong-Yu Cai, Chong Jin, Hui-Han Jin, Bo Yang, Xiao-Qing Jiang, Jian-Feng Gu, Yun-Fu Cui, Zai-Yang Zhang, Chun-Fu Zhu, Bei Sun, Chao-Liu Dai, Lin-Hui Zheng, Jing-Yu Cao, Zhe-Wei Fei, Chang-Jun Liu, Bing Li, Jun Liu, Ye-Ben Qian, Yi Wang, Ya-Wei Hua, Xi Zhang, Chang Liu, Wan-Yee Lau, Ying-Bin Liu
Tai Ren, Zi-Yu Shao, Run-Fa Bao, Yi-Jun Shu, Xiang-Song Wu, Mao-Lan Li, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Tai Ren, Yong-Sheng Li, Yang Li, Zi-Yu Shao, Run-Fa Bao, Yi-Jun Shu, Xu-An Wang, Wen-Guang Wu, Xiang-Song Wu, Mao-Lan Li, Ying-Bin Liu, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200092, China
Yong-Sheng Li, Yang Li, Xu-An Wang, Wen-Guang Wu, Ying-Bin Liu, Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Yong-Sheng Li, Ying-Bin Liu, State Key Laboratory for Oncogenes and Related Genes, Shanghai 200127, China
Xue-Yi Dang, Department of General Surgery, Shanxi Provincial Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Hong Cao, Department of GI Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Kun-Hua Wang, Department of Gastrointestinal and Hernia Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, Yunnan Province, China
Hong-Yu Cai, Department of Hepatobiliary Surgery, Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
Chong Jin, Department of General Surgery, Taizhou Municipal Hospital, Taizhou 318000, Jiangsu Province, China
Hui-Han Jin, Department of Hepatobiliary Surgery, Wuxi Second People's Hospital, Wuxi 214002, Jiangsu Province, China
Bo Yang, Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, Zhejiang Province, China
Xiao-Qing Jiang, Department of Biliary Tract Surgery, Second Military Medical University, Secondary Military Medical University, Shanghai 200438, China
Jian-Feng Gu, Department of General Surgery, Changshu No. 1 People’s Hospital Affiliated to Soochow University, Changshu 215500, Jiangsu Province, China
Yun-Fu Cui, Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Zai-Yang Zhang, Department of General Surgery, Shaoxing Second Hospital, Shaoxing 312000, Zhejiang Province, China
Chun-Fu Zhu, Department of HPB Surgery, Changzhou No. 2 People’s Hospital, Changzhou 213003, Jiangsu Province, China
Bei Sun, Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150009, Heilongjiang Province, China
Chao-Liu Dai, Department of Hepatobiliary Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Lin-Hui Zheng, Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330019, Jiangxi Province, China
Jing-Yu Cao, Department of HPB Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Zhe-Wei Fei, Department of General Surgery, Xinhua (Chongming) Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China
Chang-Jun Liu, Department of Hepatobiliary Surgery, People's Hospital of Hunan Province, Changsha 410001, Hunan Province, China
Bing Li, Department of HPB Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Jun Liu, Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Ye-Ben Qian, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Yi Wang, Department of GI Surgery, The First People's Hospital of Taicang, Taicang 215400, Jiangsu Province, China
Ya-Wei Hua, Department of General Surgery, Henan Cancer Hospital, Zhengzhou 450003, Henan Province, China
Xi Zhang, Clinical Research Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Chang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Wan-Yee Lau, Department of Liver Surgery, Chinese Univ Hong Kong, Prince Wales Hosp, Shatin, Hong Kong, China
Author contributions: Ren T, Li YS, and Dang XY contributed equally to this work; Liu YB conceived the study; Ren T, Li YS, Lau WY, Liu C, and Zhang X designed the study and analyzed the data; Ren T, Li YS, Dang XY, Li Y, Shao ZY, Bao RF, Shu YJ, Wang XA, Wu WG, Wu XS, Li ML, Cao H, Wang KH, Cai HY, Jin C, Jin HH, Yang B, Jiang XQ, Gu JF, Cui YF, Zhang ZY, Zhu CF, Sun B, Dai CL, Zheng LH, Cao JY, Fei ZW, Liu CJ, Li B, Liu J, Qian YB, Wang Y, and Hua YW collected the clinical data and followed up the patients; Ren T wrote the manuscript; Li YS, Dang XY, Zhang X, Lau WY, Liu C, and Liu YB revised the manuscript; Liu YB provided financial support for this work; Liu YB, Lau WY, and Liu C are co-corresponding authors, and contributed equally to this work; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China (General Program), No. 31620103910; National Natural Science Foundation of China (Key Program), No. 81874181; National Health Commission of China, No. 2019ZX09301158; Shanghai Municipal Commission of Economy and Informatization, No. 2019RGZN01096; Shanghai Shenkang Hospital Development Center, No. 12018107; and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 19XHCR13D.
Institutional review board statement: The protocol of the CRGGC was approved by the Committee for Ethics of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. SHEC-C-2019-085.
Informed consent statement: Written informed consent was waived and approved by the Committee for Ethics of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Bin Liu, FACS, MD, PhD, Chairman, Doctor, Professor, Shanghai Key Laboratory of Biliary Tract Disease Research, No. 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China. laoniulyb@shsmu.edu.cn
Received: October 19, 2020
Peer-review started: October 19, 2020
First decision: November 23, 2020
Revised: November 30, 2020
Accepted: December 28, 2020
Article in press: December 28, 2020
Published online: February 27, 2021
Processing time: 108 Days and 7 Hours
ARTICLE HIGHLIGHTS
Research background

Whether regional lymphadenectomy (RL) can improve prognosis in patients with T1b gallbladder cancer (GBC) remains a subject of debate.

Research motivation

To date, controversy persisted on whether RL should be routinely performed in T1b GBC. It’s necessary to provide evidence for the standardized treatment for GBC.

Research objectives

To investigate whether RL can improve the prognosis of patients with T1b GBC.

Research 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. Furthermore, we studied patients who underwent Ch + RL to compare the OS of patients who underwent combined hepatectomy (Hep) and patients who did not.

Research 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).

Research conclusions

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.

Research perspectives

Ch + RL should be routinely performed in T1b GBC patients.