Significance of Extensive Surgery Including Resection of the Pancreas Head for the Treatment of Gallbladder Cancer—From the Perspective of Mode of Lymph Node Involvement and Surgical Outcome

• Published in: World journal of surgery Vol. 30; no. 1; pp. 36 - 42
• Main Authors: Sasaki, Ryoko, Itabashi, Hidenori, Fujita, Tomohiro, Takeda, Yuichiro, Hoshikawa, Koichi, Takahashi, Masahiro, Funato, Osamu, Nitta, Hiroyuki, Kanno, Senji, Saito, Kazuyoshi
• Format: Journal Article
• Language: English
• Published: New York Springer‐Verlag 01-01-2006; Springer; Springer Nature B.V
• Subjects: Aged; Bile Duct Carcinoma; Biliary Tract Carcinoma; Biological and medical sciences; Female; Gallbladder - surgery; Gallbladder Cancer; Gallbladder Carcinoma; Gallbladder Neoplasms - mortality; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Liver Neoplasms - secondary; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lymph Node Excision; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Pancreas - surgery; Pancreatectomy; Regional Lymphadenectomy; Tumors; Head; Prognosis; Biliary tract cancer; Surgical resection; Malignant tumor; Biliary tract disease; Gallbladder cancer; Medicine; Gall bladder cancer; Treatment; Adenopathy; Surgery; Digestive diseases; Evolution; Pancreas
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-005-0181-z

The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node‐positive disease and among them 23.1% had positive para‐aortic nodes. Of six node‐positive 5‐year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5‐year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas‐preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.