Annals of Surgical Oncology

, Volume 22, Issue 8, pp 2779–2786 | Cite as

Surgical Strategy for T2 Gallbladder Cancer According to Tumor Location

  • Huisong Lee
  • Dong Wook Choi
  • Jin Young Park
  • Sangmin Youn
  • Wooil Kwon
  • Jin Seok Heo
  • Seong Ho Choi
  • Kee-Taek Jang
Hepatobiliary Tumors



Radical cholecystectomy is recommended for T2 gallbladder cancer. However, it is unclear whether hepatic resection is essential for peritoneal-side gallbladder cancer.


From January 2000 to December 2011, we identified T2 gallbladder cancer patients who had undergone curative intent surgery. A peritoneal-side tumor was defined when the epicenter of the tumor was located within the free peritoneal-side gallbladder mucosa. Hepatic-side gallbladder cancer was defined when the epicenter of the tumor was located within the gallbladder bed or neck.


A total of 157 patients with T2 gallbladder cancer were included; 33 peritoneal-side and 124 hepatic-side tumors. In total, 122 patients underwent hepatic resection, whereas the remaining 35 patients did not. After a median follow-up period of 40 (range 5–170) months, the survival of the peritoneal-side group was better than that of the hepatic-side group (p = 0.002). In a multivariate analysis, tumor location, lymph node metastasis, hepatic resection, lymphatic invasion, and perineural invasion were significant prognostic factors (p = 0.045, p < 0.001, p = 0.003, p = 0.046, and p = 0.027, respectively). For the peritoneal-side group, there was no recurrence or death after cholecystectomy without hepatic resection. However, hepatic resection was an important factor associated with overall survival in patients with hepatic-side gallbladder cancer (p = 0.007).


In T2 gallbladder cancer patients, hepatic resection is recommended when there is tumor invasion of the gallbladder bed or neck. However, it is not always necessary in selected patients with peritoneal-side gallbladder cancer.


Lymph Node Dissection Hepatic Resection Cystic Duct Gallbladder Cancer Lymph Node Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



There has been no grant support.


Huisong Lee, Dong Wook Choi, Jin Young Park, Sangmin Youn, Wooil Kwon, Jin Seok Heo, Seong Ho Choi, and Kee-Taek Jang have none to declare.


  1. 1.
    You DD, Lee HG, Paik KY, Heo JS, Choi SH, Choi DW. What is an adequate extent of resection for T1 gallbladder cancers? Ann Surg. 2008;247:835-8.PubMedCrossRefGoogle Scholar
  2. 2.
    Choi SB, Han HJ, Kim CY, et al. Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection. J Gastrointest Surg. 2010;14:668-78.PubMedCrossRefGoogle Scholar
  3. 3.
    Dai M, Fong Y, Lowy A. Treatment of T3 gallbladder cancer. J Gastrointest Surg. 2009;13:2040-2.PubMedCrossRefGoogle Scholar
  4. 4.
    Kohya N, Miyazaki K. Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol. 2008;97:498-502.PubMedCrossRefGoogle Scholar
  5. 5.
    Wise PE, Shi YY, Washington MK, et al. Radical resection improves survival for patients with pT2 gallbladder carcinoma. Am Surg. 2001;67:1041-7.PubMedGoogle Scholar
  6. 6.
    Schnelldorfer T, Sarr MG, Adams DB. What is the duct of Luschka? A systematic review. J Gastrointest Surg. 2012;16:656-62.PubMedCrossRefGoogle Scholar
  7. 7.
    Shindoh J, de Aretxabala X, Aloia TA, et al. Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study. Ann Surg. 2014. doi: 10.1097/SLA.0000000000000728.
  8. 8.
    Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual, 7th edn. Springer, New York, 2010.Google Scholar
  9. 9.
    Foster JM, Hoshi H, Gibbs JF, et al. Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol. 2007;14:833-40.PubMedCrossRefGoogle Scholar
  10. 10.
    Angelsen JH, Horn A, Eide GE, Viste A. Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival. World J Surg Oncol. 2014;12:127.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Liu GJ, Li XH, Chen YX, Sun HD, Zhao GM, Hu SY. Radical lymph node dissection and assessment: Impact on gallbladder cancer prognosis. World J Gastroenterol. 2013;19:5150-8.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Harada K, Ochiai T, Inoue K, et al. Optimal surgical treatment for patients with pT2 gallbladder cancer. Hepatogastroenterology. 2011;58:14-9.PubMedGoogle Scholar
  13. 13.
    Gadzijev EM. Surgical anatomy of hepatoduodenal ligament and hepatic hilus. J Hepatobiliary Pancreat Surg. 2002;9:531-3.PubMedCrossRefGoogle Scholar
  14. 14.
    Miyakawa S, Ishihara S, Horiguchi A, Takada T, Miyazaki M, Nagakawa T. Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg. 2009;16:1-7.PubMedCrossRefGoogle Scholar
  15. 15.
    Kiran RP, Pokala N, Dudrick SJ. Incidence pattern and survival for gallbladder cancer over three decades–an analysis of 10301 patients. Ann Surg Oncol. 2007;14:827-32.PubMedCrossRefGoogle Scholar
  16. 16.
    Ito H, Ito K, D’Angelica M, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254:320-5.PubMedCrossRefGoogle Scholar
  17. 17.
    Shirai Y, Sakata J, Wakai T, Ohashi T, Ajioka Y, Hatakeyama K. Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes. World J Surg Oncol. 2012;10:87.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Suzuki S, Yokoi Y, Kurachi K, et al. Appraisal of surgical treatment for pT2 gallbladder carcinomas. World J Surg. 2004;28:160-5.PubMedCrossRefGoogle Scholar
  19. 19.
    Choi SB, Han HJ, Kim WB, Song TJ, Suh SO, Choi SY. Surgical strategy for T2 and T3 gallbladder cancer: is extrahepatic bile duct resection always necessary? Langenbecks Arch Surg. 2013;398:1137-44.PubMedCrossRefGoogle Scholar
  20. 20.
    Wiggers JK, Koerkamp BG, Ovadia Z, Busch OR, Gouma DJ, van Gulik TM. Patterns of recurrence after resection of gallbladder cancer without routine extrahepatic bile duct resection. HPB (Oxford). 2014;16:635-40.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Hueman MT, Vollmer CM Jr, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 2009;16:2101-15.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Huisong Lee
    • 1
  • Dong Wook Choi
    • 1
  • Jin Young Park
    • 1
  • Sangmin Youn
    • 1
  • Wooil Kwon
    • 1
  • Jin Seok Heo
    • 1
  • Seong Ho Choi
    • 1
  • Kee-Taek Jang
    • 2
  1. 1.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Department of Pathology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

Personalised recommendations