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

Area of Science:

• Surgical Oncology
• Hepatobiliary Surgery
• Gastroenterology

Background:

• Radical cholecystectomy for gallbladder cancer (GBC) involves liver resection.
• Two techniques exist: non-anatomical wedge resection and anatomical segment 4b+5 resection.
• Limited prospective data compares these liver resection methods in GBC.

Purpose of the Study:

• To compare anatomical segment 4b+5 resection versus wedge resection in radical cholecystectomy for GBC.
• To evaluate differences in surgical and oncological outcomes between the two liver resection techniques.

Main Methods:

• A single-centre, phase 3, open-label, randomized controlled trial (RCT) with 1:1 allocation.
• 163 patients with GBC were randomized intraoperatively to either segment 4b+5 or wedge resection.
• Outcomes assessed included surgical parameters, morbidity, mortality, R0 resection rates, disease-free survival (DFS), and overall survival (OS).

Main Results:

• The segment 4b+5 group had longer surgery duration (318 vs. 287 min) and higher blood loss (265 vs. 223 ml) compared to the wedge group.
• No significant differences were observed in morbidity, mortality, or R0 resection rates between the two groups.
• At a median follow-up of 27 months, mean DFS was 41.8 months (4b/5) vs. 44.7 months (wedge), and mean OS was 45.3 months (4b/5) vs. 50.7 months (wedge).

Conclusions:

• Anatomical segment 4b+5 resection and wedge resection yield similar long-term oncological outcomes (DFS and OS) in radical cholecystectomy for GBC.
• The specific type of liver resection employed does not appear to influence the long-term oncological results for GBC.
• Surgical outcomes like duration and blood loss may differ, but do not translate to differences in survival or recurrence.