BACKGROUND/PURPOSE: Surgical resection remains the only potentially curative treatment for advanced gallbladder cancer (GBC). However, preoperative diagnosis and staging are often challenging, and the indication for extended resection remains controversial. This study evaluated the feasibility of upfront resection for advanced GBC based on clinical T (cT) staging. METHODS: Patients radiologically diagnosed with cT3 or cT4 GBC at six Japanese centers between 2010 and 2022 were retrospectively analyzed. Resection rate, benign lesions, perioperative outcomes, and overall survival (OS) were compared between the groups. RESULTS: Among 300 patients (cT3, n = 182; cT4, n = 118), 260 (87%) underwent resection. Benign lesions were identified in 21 (8%) patients. Compared with cT3, cT4 tumors had higher rates of extended resection (75% vs. 40%, p < 0.001), exploratory laparotomy (24% vs. 7%, p < 0.001), and postoperative complications (59% vs. 29%, p < 0.001). Postoperative mortality tended to be higher in cT4 patients (7% vs. 3%, p = 0.197), and median OS was significantly shorter (22 vs. 44 months, p < 0.001). CONCLUSIONS: Clinical T staging helps guide treatment planning for advanced GBC. Upfront resection is feasible for cT3 GBC, whereas cT4 disease is associated with extensive surgery and poor outcomes.
Kato et al. (Mon,) studied this question.