Segment 4b/5 Versus Wedge Resection for Gallbladder Adenocarcinoma: A Randomized Controlled Trial.

Abstract

The 2 techniques for liver resection during radical cholecystectomy for gallbladder cancer (GBC) are: nonanatomical wedge resection (wedge) and anatomic segment 4b+5 resection (4b/5). There is a lack of prospective studies and randomized controlled trials (RCT) comparing these 2 techniques. So we conducted this RCT to compare these 2 techniques with respect to surgical and oncological outcomes. It was a single-center, phase 3, balanced allocation (1:1), and open-label RCT. Patients undergoing surgery for GBC were randomized intraoperatively to wedge or segment 4b/5 resection after ruling out metastatic or unresectable disease. A total of 163 patients were included in final analysis (4b/5=83, wedge=80). Both the groups were similar in baseline characteristics. Segment 4b/5 group had significantly longer duration of surgery (318 vs. 287 min, P =0.009) and higher blood loss (265 mL vs. 223 mL, P =0.05). But there was no difference in morbidity, mortality, and R0 resection rates. At a median follow-up of 27 months mean DFS for segment 4b/5 and wedge group was 41.8 months and 44.7 months, respectively (HR: 0.8, 95% CI: 0.47-1.4, P =0.50). Mean OS for segment 4b/5 and wedge group was 45.3 months and 50.7 months, respectively (HR:0.6, 95% CI: 0.36-1.14, P =0.12). Anatomic segment 4b/5 resection and wedge resection had similar morbidity, mortality, DFS, and OS. So type of liver resection in radical cholecystectomy did not have any impact on long-term oncological outcomes.