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

BACKGROUND AND OBJECTIVES The two techniques for liver resection during radical cholecystectomy for gall bladder cancer (GBC) are: non anatomical wedge resection (wedge) and anatomical segment 4b+ 5 resection (4b/5). There is a lack of prospective studies and randomized controlled trials (RCT) comparing these two techniques . So we conducted this RCT to compare these two techniques with respect to surgical and oncological outcomes. PATIENTS AND METHODS It was a single-centre, phase 3, balanced allocation (1:1) and open-label RCT. Patients undergoing surgery for GBC were randomised intraoperatively to wedge or segment4b/5 resection after ruling out metastatic or unresectable disease. RESULTS A total of 163 patients were included in final analysis( 4b/5=83, wedge=80). Both the groups were similar in baseline characteristics. Segment4b/5 group had significantly longer duration of surgery ( 318 versus 287 min, P=0.009) and higher blood loss (265 ml versus 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 segment4b/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). CONCLUSION Anatomical 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.