T1b/T2期胆囊癌根治性手术中肝切除术时机与临床疗效及预后的关系OA北大核心CSTPCD

Background and aims:Gallbladder cancer(GBC)is the most common malignancy of the biliary system.According to the AJCC TNM staging system(8th edition),T1b/T2 stage GBC patients require radical surgery,including cholecystectomy,hepatectomy,and regional lymph node dissection.Timing options for surgery include cholecystectomy combined with hepatectomy and secondary hepatectomy based on postoperative pathological diagnosis of GBC.Currently,there is limited research on the timing of hepatectomy in radical surgery for GBC.Therefore,this study was perfromed to investigate the impact of timing selection for hepatectomy during radical surgery for GBC on perioperative variables and long-term prognosis of patients. Methods:The data of 114 patients with T1b/T2 stage GBC who underwent radical surgery in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 2011 to August 2018,were retrospectively collected.Among them,82 patients underwent cholecystectomy combined with hepatectomy(one-stage group),and 32 patients underwent secondary hepatectomy after cholecystectomy(two-stage group).After balancing the baseline data of the two groups using propensity score matching(PSM),differences in overall survival(OS)and disease-free survival(DFS)were compared,factors influencing OS and DFS of patients were analyzed,and differences in operative time and length of hospital stay between the two groups were also compared.Additionally,within the two-stage group,differences in perioperative indicators and prognosis were compared between patients with different time intervals for surgery(≤20 d vs.＞20 d). Results:After 1∶1 PSM,there were 28 cases in each group,with statistically significant difference only in the time of GBC diagnosis(P＜0.05),while other baseline data were balanced and comparable(all P＞0.05).Survival analysis showed no statistically significant differences in OS and DFS between the two groups(all P＞0.05).The analysis of risk factors revealed that only male gender was an independent risk factor for OS(HR=2.237,95％ CI=1.119-4.473,P=0.023),while timing of surgery and other factors showed no significant relationship with OS and DFS(all P＞0.05).There were no statistically significant differences in operative time and length of hospital stay between the two groups(all P＞0.05).Different time intervals for secondary hepatectomy had no significant impact on perioperative variables and prognosis of patients(all P＞0.05). Conclusion:For T1b/T2 stage GBC patients,secondary hepatectomy has a comparable impact on efficacy and long-term prognosis compared to one-stage hepatectomy.Moreover,different time intervals for secondary hepatectomy within a 4-week window do not significantly affect prognosis.