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Muscle-invading gallbladder tumours on the free side of the organ recur in the liver far less often than those against it. Two meta-analyses found the liver resection helped only the liver-side group, so a randomised trial could test dropping it for the free side.
Shindoh (2015) showed liver recurrence of 3 percent for peritoneal-side against 23 percent for hepatic-side T2 tumours; Kang's meta-analysis (1,789 patients) found no survival difference between extended and simple cholecystectomy in T2a (odds ratio 0.802) and Khan's (2,345 patients) found liver resection improved survival only in T2b. Lymphadenectomy would be retained because T2a nodal metastasis is still 27 percent. Reproducible assignment of side on pathology is the practical obstacle and would need a central review protocol.
The prognostic split is solid; the surgical consequence is not. Whether T2a tumours can safely skip liver resection, and whether T2b tumours gain from it, is a randomised or prospective-registry question that nobody has yet run.
Consistent with Kang and colleagues on prognosis, and more optimistic about liver resection for T2b. The adjuvant chemotherapy finding is retrospective and predates gallbladder-specific analysis of BILCAP, but it is a warning that the adjuvant benefit in this disease is not established.
The study behind the T2a/T2b split adopted by the AJCC eighth edition in 2017, the one staging change in gallbladder cancer that grew from the disease's own anatomy rather than from bile duct cancer.
One of the series that raised the question of sparing the liver resection in T2a disease; only 33 peritoneal-side tumours, so it poses the question rather than settles it.
Shares De-escalation, escalation and response-adapted therapy, Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Surgery and radiotherapy cure most, get least and the tag gallbladder-evidence.
Shares Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study, T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side), Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Radical (extended) cholecystectomy, Lymphadenectomy (lymph node dissection), Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Trial design, endpoints and cost, Gallbladder cancer and the tag gallbladder-evidence.
Shares Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side), Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.