Reappraising the prognostic role of liver resection as part of extended cholecystectomy for T2 gallbladder cancer

The role of liver resection (LR) as extended cholecystectomy for T2 gallbladder cancer (GBC) remains controversial. 100 patients with pathological (p) T2 GBC who underwent curative surgery between 2003 and 2023 were retrospectively analyzed. Prognostic outcomes were compared between patients who underwent LR (LR+) and those who did not (LR–), with subgroup analyses by T2 substage. To assess the accuracy of preoperative T staging, 72 additional pT1/3 patients who underwent surgical resection during the same study period were evaluated. The LR+ (n ​= ​78) and LR– (n ​= ​22) groups showed no differences in overall survival (OS, P ​= ​0.552) or recurrence-free survival (RFS, P ​= ​0.538). Subgroup analyses showed no survival advantage with LR in both T2a and T2b cases. A multivariable analysis identified lymph node metastasis, elevated CA19-9, and tumor location (neck) as independent predictors of OS, but not LR ( P ​= ​0.806). Similarly, LR was not a risk factor for RFS ( P ​= ​0.677). Local recurrence occurred in one patient (LR ​+ ​group). Diagnostic accuracy of T2 was 64.5 ​%. 2 cases of clinical T2b cases were upstaged to pT3. LR did not provide clear oncological benefits in T2 GBC when adequate preoperative and intraoperative assessment was ensured. For T2a tumors, LR is likely to be omitted without compromising oncological outcomes. For even T2b cases, omission may be considered when hepatic invasion is carefully excluded. Liver resection along gallbladder bed did not provide oncological benefits in T2 gallbladder cancer.