Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

Table 1 Extent of tumor spread by ss score

Vertical invasion	< 1/3 in depth	α: score 1
	≥ 1/3 and < 2/3	β: score 2
	≥ 2/3	γ: score 3
Horizontal invasion	< 5 mm	A: score 1
	≥ 5 mm and < 10 mm	B: score 2
	≥ 10 mm	C: score 3

The sum total of ss score was calculated. ss minimum (ss min): 2; ss medium (ss med): 3-4; ss massive (ss mas): 5-6.

Table 2 ss score and clinicopathological factors n (%)

	ss min (n = 4)	ss med (n = 10)	ss mas (n = 16)
h-inf (+)	0	5 (50.0)	2 (12.5)
b-inf (+)	0	0	1 (6.3)
ly (+)	0	6 (60.0)	15 (93.8)
v (+)	0	0	5 (35.7)
pn (+)	0	1 (10.0)	6 (37.5)
n (+)	0	3 (30.0)	4 (25.0)

h-inf: Hepatic invasion; b-inf: Bile duct invasion; ly: Lymphatic invasion; v: Venous invasion; pn: Peri-neural invasion; n: Lymph node metastasis.

Table 3 Surgical procedures in T2 gallbladder carcinoma

Surgical procedure	ss min (n = 4)	ss med (n = 10)	ss mas (n = 16)
Cx	3	2	3
Cx + Liver bed resection + D2ex			1
Cx + BDR + D2ex	1	2	1
S4a5 hepatectomy + D2ex		2	3
S4a5 hepatectomy + BDR+ D2ex		2	5
S4a5 hepatectomy + PD or PPPD		2	1
Extended right hepatectomy			1
PD alone			1

BDR: Bile duct resection; PD: Pancreatoduodenectomy; PPPD: Pylorus-preserving PD.