1. Hepatectomy strategy for T2 gallbladder cancer between segment IVb and V resection and wedge resection: A propensity score-matched study.
- Author
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Chen, Mingyu, Cao, Jiasheng, Xiang, Yukai, Ma, Xiaochen, Bai, Yang, Lai, Qihong, Tong, Chenhao, Ma, Zuyi, Topatana, Win, Hu, Jiahao, Li, Shijie, Juengpanich, Sarun, Yu, Hong, and Cai, Xiujun
- Abstract
Liver resection is recommended for T2 gallbladder cancer, but the optimal hepatectomy strategy remains controversial. We aimed to assess the safety and effectiveness of segment IVb and V resection versus wedge resection in patients with T2 gallbladder cancer. This is a retrospective multicenter propensity score-matched study in China. Overall survival, disease-free survival, perioperative complications, and hospital length of stay were used to evaluate safety and effectiveness. There are a total of 512 patients. 112 of 117 patients undergoing segment IVb and V resection were matched to 112 patients undergoing wedge resection. After matching, segment IVb and V resection demonstrated no statistical difference in overall survival (hazard ratio, 0.970 [0.639–1.474]; P =.886), but significance in disease-free survival (hazard ratio, 0.708 [0.506–0.991]; P =.040). Patients with incidental gallbladder cancer (hazard ratio, 0.390 [0.180–0.846]; P =.019), stage T2b (hazard ratio, 0.515 [0.302–0.878]; P =.016), and negative lymph nodes status (hazard ratio, 0.627 [0.406–0.991]; P =.043) were associated with improved disease-free survival after segment IVb and V resection, but not in wedge resection. However, perioperative complications occurred more frequently after segment IVb and V resection (28.5% vs 9.1%, P <.001) along with the longer hospital length of stay (17.3 vs 10.2 days, P <.001). Notably, patients with jaundice (odds ratio, 4.053 [1.361–12.23]; P =.013), undergoing laparoscopic resection (odds ratio, 2.387 [1.059–4.484]; P =.028) or surgeon performing per the first 10 segment IVb and V resections (odds ratio, 2.697 [1.035–6.998]; P =.041), were the independent risk factors for perioperative complications in the segment IVb and V resection group. T2 gallbladder cancer patients undergoing segment IVb and V resection rather than wedge resection have an improved disease-free survival, especially for incidental gallbladder cancer or hepatic-sided (T2b) gallbladder cancer. However, high rates of perioperative complications and longer hospital length of stay after segment IVb and V resection indicated that surgeons must rely on their own surgical skills and the patient profile to decide the optimal hepatectomy strategy. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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