Systematic review on the surgical treatment for T1 gallbladder cancer

Table 1 Characteristics of included studies on surgical treatment of patients with T1 gallbladder cancer

Authors	Yr	No. of patients	Primary outcome		Secondary outcome
			3 YSR	5 YSR	Morbidity	Mortality	Recurrence
Ogura et al[13]	1991	3661					NS
Shirai et al[26]	1992	89	NS	NS	NS
Ouchi et al[11]	1994	15	NS		NS
Chijiiwa et al[28]	1994	5	NS		NS
de Aretxabala et al[14]	1997	24	NS		NS		NS
Mori et al[22]	1997	9	NS	NS	NS
Benoist et al[1]	1998	362
Z'graggen et al[29]	1998	9		NS	NS
Shimada et al[9]	2000	17			NS
Suzuki et al[30]	2000	25	NS		NS
Wakai et al[6]	2001	25	NS		NS
Puhalla et al[24]	2002	9		NS
Wagholikar et al[7]	2002	14	NS		NS
Kim et al[17]	2002	19	NS		NS
Ouchi et al[18]	2002	2343	NS		NS
Wakai et al[10]	2002	15	NS		NS
Cucinotta et al[4]	2005	12	NS	NS	NS
Yildirim et al[15]	2005	13
Eguchi et al[31]	2005	12	NS	NS	NS
Sun et al[19]	2005	15	NS		NS
Otero et al[32]	2006	51	NS		NS
Yagi et al[8]	2006	13	NS		NS
Chan et al[12]	2006	33	NS	NS	NS
Cangemi et al[27]	2006	15	NS
Kang et al[16]	2007	11	NS
You et al[3]	2008	52	NS
Kwon et al[20]	2008	20	NS		NS
Kohya et al[21]	2008	15	NS		NS		NS
Goetze et al[5]	2008	934	NS		NS

¹Japan survey from 172 major hospitals;

²French cooperative group AURC (Association Universitaire de Recherche en Chirurgie);

³Japan nationwide survey on laparoscopic cholecystectomy from 253 hospitals;

⁴German Registry of Incidental Gallbladder Carcinoma of the German Society of Surgery. NS: Not stated.

Table 2 Surgical procedures for mucosa and T1b gallbladder cancer n (%)

	T1a (n = 706)	T1b (n = 560)	P value	Total (n = 1266)
Simple cholecystectomy	590 (83.6)	375 (67.0)	< 0.01	965 (76.2)
Open cholecystectomy	321 (54.4)	286 (76.3)	< 0.01	607 (62.9)
Laparoscopic cholecystectomy	269 (45.6)	89 (23.7)		358 (37.1)
Extended cholecystectomy	110 (15.6)	168 (30.0)	< 0.01	278 (22.0)
2nd operation	16 (14.5)	43 (25.6)		59 (21.2)
Major hepatectomy	6 (0.8)	16 (2.9)	NS	22 (1.7)
Pancreatoduodenctomy	0	1 (0.2)	NS	1

NS: Not stated.

Table 3 Lymph node metastasis of T1 gallbladder cancer n (%)

	T1a (n = 280)	T1b (n = 276)	P value	Total (n = 556)
Lymphovascular invasion	7 (2.5)	33 (12.0)	< 0.01	40 (7.2)
Perineural invasion	1 (0.4)	7 (2.5)	NS	8 (1.4)
Lymph node metastasis	5 (1.8)	30 (10.9)	< 0.01	35 (6.3)

NS: Not stated.

Table 4 Studies reporting lymph node metastasis of T1 gallbladder cancer n (%)

	T1a	T1b	Odds ratio	95% CI
Goetze et al[5]	0/21	1/72 (1.4)	1.296	1.159-1.448
Yildirim et al[15]	0/5	1/8 (12.5)	1.714	1.063-2.765
You et al[3]	0/27	2/25 (8.0)	2.174	1.610-2.935
Kim et al[17]	0/10	1/9 (11.1)	2.250	1.342-3.771
Ogura et al[13]	5/201 (2.5)	25/165 (15.2)	7.000	2.616-18.733

Table 5 Studies reporting recurrence cases of T1 gallbladder cancer n (%)

	T1a	T1b	Odds ratio	95% CI
You et al[3]	1/27 (3.7)	0/25	0.510	0.39-0.67
Shirai et al[26]	2/78 (2.6)	0/11	0.874	0.81-0.95
Wakai et al[10]	1/13 (7.7)	0/2	0.923	0.79-1.08
Z'graggen et al[29]	0/3	1/6 (16.7)	1.200	0.84-1.72
Wagholikar et al[7]	0/2	5/12 (41.7)	1.286	0.91-1.82
Goetze et al[5]	0/21	14/72 (19.4)	1.362	1.19-1.56
Cangemi et al[27]	0/4	5/11 (45.4)	1.667	1.01-2.77
Kim et al[17]	0/10	1/9 (11.1)	2.250	1.34-3.77
Chan et al[12]	1/14 (7.1)	3/19 (15.8)	2.438	0.23-26.29
Otero et al[32]	0/25	9/26 (34.6)	2.471	1.71-3.57
Ouchi et al[11]	1/8 (12.5)	3/7 (42.9)	5.250	0.40-68.94
Ouchi et al[18]	1/167 (0.6)	3/67 (4.5)	7.781	0.79-76.19
Cucinotta et al[4]	1/5 (20)	6/7 (85.7)	24.000	1.14-505.2
Wakai et al[6]	0	2/25 (8.0)

Table 6 Recurrence cases of T1a gallbladder cancer after surgical treatment (n = 8)

	Operation	Time of recurrence (mo)/site	Survival after op (mo)
Shirai et al[26]	NA1	NA/CBD	76
	NA1	NA/CBD	66
Ouchi et al[11]	Simple cholecystectomy	NA/CBD	45
Ouchi et al[18]	Laparoscopic cholecystectomy2	NA/NA	NA
Wakai et al[10]	Laparoscopic cholecystectomy	NA/P. seeding	52
Cucinotta et al[4]	Laparoscopic cholecystectomy	7/Port site	20
Chan et al[12]	Laparoscopic cholecystectomy	48.3/liver, lung	51
You et al[3]	Laparoscopic cholecystectomy	3/CBD	19

¹Cystic duct margin (+) patients;

²Gallbladder perforation during laparoscopic chlecystectomy. CBD: Common bile duct; NA: Not available.

Table 7 Recurrence pattern of T1b gallbladder cancer after surgical treatment n (%)

	Simple cholecystectomy (n = 375)	Extended cholecystectomy (n = 185)
Loco-regional recurrence	12 (50.0)
CBD	3 (6.4)
Lymph node	5 (10.6)
Port site	4 (8.5)
Systemic recurrence	12 (50.0)	3 (60)
Liver	7 (14.9)	2 (40)
Peritoneal seeding	4 (8.5)
Lung	1 (2.0)	1 (20)
Unknown	23 (48.9)	2 (40)
Totalb	47 (12.5)	5 (2.7)

^bP < 0.01. CBD: Common bile duct.

Table 8 Five-year survival rates of patients with T1a and T1b gallbladder cancer after surgical treatment

	N	5 YSR (%)
	T1 (T1a/T1b)	T1a (SC/EC)	T1b (SC/EC)	T1 (SC/EC)
Benoist et al[1]	361 (13/23)	45	44	44
You et al[3]	52 (27/25)	96.3	96	96.2
de Aretxabala et al[14]	24 (11/13)	100	75	75
Kang et al[16]	11 (3/8)	100	100	100
Sun et al[19]	15 (10/5)	100	100	100
Kwon et al[20]	20 (18/2)	100	100	100
Kohya et al[21]	15 (8/7)	100	100	100
Yildirim et al[15]	13 (5/8)	100 (100/100)	80 (50/100)	90
Kim et al[17]	19 (10/9)	100 (100/100)	100 (100/100)	100
Ouchi et al[11]	15 (8/7)	(71/100)	(42/100)
Cangemi et al[27]	15 (4/11)	100	(37.5/100)
Ogura et al[13]	366 (201/165)	82.6	72.5
Ouchi et al[18]	234 (167/67)	99	95
Otero et al[32]	51 (25/26)	70
Goetze et al[5]	93 (21/72)		(42/79)
Wakai et al[6]	25 (0/25)		87 (100/75)
Wagholikar et al[7]	14 (2/12)			68
Shimada et al[9]	17 (10/7)			86.7
Eguchi et al[31]	25 (19/6)			92
Wakai et al[10]	15 (13/2)			(90/100)
Yagi et al[8]	13 (12/1)			100

¹All patients underwent simple cholecystectomy. SC: Simple cholecystectomy; EC: Extended cholecystectomy.

Table 9 Five-year survival rates of patients with T1b gallbladder cancer after different surgical procedures

	N (SC/EC)	5 YSR (%)		P value
		SC	EC
Wakai et al[6]	25 (17/8)	100	75	NS
Kim et al[17]	9 (6/3)	100	100	NS
Yildirim et al[15]	8 (5/3)	50	100	NS
Ouchi et al[11]	7 (5/2)	42	100	< 0.05
Cangemi et al[27]	11 (8/3)	37.5	100	< 0.01
Goetze et al[5]	72 (49/23)	42	79	0.03

NS: Not significant; SC: Simple cholecystectomy; EC: Extended cholecystectomy.

Table 10 Clinical outcome of laparoscopic cholecystectomy for T1a and T1b gallbladder cancer

	N		Recurrence		5 YSR (%)
	T1a	T1b	T1a	T1b	T1a	T1b
Mori et al[22]	7	2	0	0
Kim et al[17]	9	6	0	1 (port site)	100	100
Sun et al[19]	10	5	0	0	100	100
Eguchi et al[31]	13	5	0	0	100	100
Kwon et al[20]	18	2	0	0	100	100
Ouchi et al[18]	167	67	11	31	99	95

¹Site was not described.