Prognostic Effect of Liver Resection in Extended Cholecystectomy for T2 Gallbladder Cancer Revisited

Objective: In this study, we evaluated the effect of liver resection on the prognosis of T2 gallbladder cancer (GBC). Summary Background Data: Although extended cholecystectomy (lymph node dissection [LND] + liver resection) is recommended for T2 GBC, recent studies have shown that liver resection does not improve survival outcomes relative to LND alone. Methods: Patients with pT2 GBC who underwent extended cholecystectomy as an initial procedure and not reoperation after cholecystectomy at three tertiary referral hospitals between January 2010 and December 2020 were analyzed. Extended cholecystectomy was defined as either LND with liver resection (LND+L group) or LND only (LND group). We conducted 2:1 propensity score matching to compare the survival outcomes of the groups. Results: Of the 197 patients enrolled, 100 patients from the LND+L group and 50 from the LND group were successfully matched. The LND+L group experienced greater estimated blood loss ( P < 0.001) and a longer postoperative hospital stay ( P =0.047). There was no significant difference in the 5-year disease-free survival (DFS) of the two groups (82.7% vs. 77.9%, respectively, P =0.376). A subgroup analysis showed that the 5-year DFS was similar in the two groups in both T substages (T2a: 77.8% vs. 81.8%, respectively, P =0.988; T2b: 88.1% vs. 71.5%, respectively, P =0.196). In a multivariable analysis, lymph node metastasis (hazard ratio [HR] 4.80, P =0.006) and perineural invasion (HR 2.61, P =0.047) were independent risk factors for DFS; liver resection was not a prognostic factor (HR 0.68, P =0.381). Conclusions: Extended cholecystectomy including LND without liver resection may be a reasonable treatment option for selected T2 GBC patients.