T3 gallbladder cancer: surgical outcomes according to the mode of tumor spread and treatment considerations for oncological resectability.

BACKGROUND

This study aimed to clarify surgical outcomes for patients with pT3 gallbladder cancer according to the mode of tumor spread.

METHODS

A total of 85 patients with pT3 gallbladder cancer who underwent curative-intent surgery were analyzed. Each tumor was classified according to the mode of spread.

RESULTS

Five-year overall survival (OS) in patients with involvement of the liver alone (n = 25), involvement of the extrahepatic bile duct alone (n = 29), involvement of one other organ/structure alone or perforation of the peritoneal side of the serosa alone (n = 9), and involvement of both the liver and one other organ/structure (n = 22) was 36.0%, 29.0%, 22.2%, and 9.1%, respectively. For patients with involvement of the liver alone, 5-year OS was > 30% regardless of type of hepatectomy. Among 29 patients with involvement of the extrahepatic bile duct alone, 8 patients survived ≥ 5 years; 3 underwent extended cholecystectomy and 5 underwent more extensive resection. Despite performing extensive resection, 5-year OS was 12.5% for patients with involvement of both the liver and one other organ/structure. The mode of spread other than involvement of the liver alone or extrahepatic bile duct alone was an independent predictor of worse OS (hazard ratio 1.675; p = 0.046).

CONCLUSIONS

Surgery is an acceptable option for pT3 gallbladder cancer with involvement of the liver alone or extrahepatic bile duct alone regardless of the type of resection procedure. However, the survival benefit of surgery is limited for this tumor with other modes of spread.