Optimal surgical treatment for patients with pT2 gallbladder cancer.

Objective: Wall invasion is one of the significant prognostic factors of gallbladder cancer (GBC). Even extended surgery associated with hepatectomy does not always improve the prognosis of pathological T2 (pT2) (the tumor invades perimuscular connective tissue pathologically) GBC patients. The purpose of this study was to identify factors associated with long-term survival of pT2 GBC patients.

Methods: Fifty-three patients with GBC had undergone radical resection from 1995 to 2009 in our institution. Among them, there were 23 pT2 patients. We reviewed clinico-pathologic features of the pT2 GBC patients and evaluated prognostic factors.

Results: The 5-year survival rates for pT1, pT2, pT3, and pT4 in TNM classification by the International Union against Cancer (UICC) were 100%, 55.2%, 38.5% and 25.0%, respectively. In the 23 patients with pT2 GBC, the absence of lymph node metastasis and a periductal cancer-free surgical margin were significant favorable factors by univariate analysis. The 5-year survival rate of pT2 GBC patients with a periductal cancer-free surgical margin was 65.8% and that of pT2 GBC patients who did not have lymph node metastasis was 71.2%.

Conclusions: In the treatment of pT2 GBC patients, radical resection to achieve RO including surgical margins and lymph nodes in spite of surgical procedures contributes to a better survival.