Radical Operation for Advanced Gallbladder Carcinoma

Fujio Hanyu

Department of Gastroenterological Surgery, Tokyo Women's Medical College

The modes of tumor spread and results of surgery in 164 patients with advanced gallbladder cancer resected between 1968 and 1990 were evaluated retrospectively. All of the gallbladder cancers located in the fundus or body with direct invasion through the liver bed (liver bed type) were localized tumors apread in the liver parenchyma, whereas 80% of the tumors located in the neck (hilus type) were invasive tumors spread in the liver along Glisson's sheath of the hilus of the liver. Lymphatic spread, vascular spread, and neural spread in the hepatoduodenal ligament accounted for 84%, 7l%, and 75%, respectively. Positive lymph node metastasis was related to the depth of cancer invasion in the gallbladder wall. The incidence of positive lymph node metastasis, in ss cancer which extended over one area, either fundus or body, or in ss cancer which was located in the area of neck, or in the se or more serious cancer, were in the range of 55% to 86%. Positive lymph node metastasis surrounding the head of the pancreas was found in half of the patients with these cancers. The curability in this series was 41%. The most important factor which prevented curative resection was positive surgical margin in the hepatoduodenal ligament in the patients with ae or more serious cancer. Hospital deaths occurred in half of the patients who underwent right hepatectomy with pancreatoduodenectomy (rHPD) or hepatoligamentopancreatoduodenectomy (HLPD). In the patients with se or more serious cancer with positive n2 or more distant lymph node metastasis, the survival rate for the patients who underwent hepatopancreatoduodenectomy (HPD) was significantly better than than that for the patients who underwent non-HPD therapy. We conclude that patients with advanced gallbladder cancer should undergo HPD, and we especially advocate rHPD for patients with hilus type cancer and HLPD for patients with positive surgical margin in hepatoduodenal ligament. However, there still remains the problem of the significant risk of operative death following these extended procedures. Post operative liver failure is the most important problem to be solved.

Key words
hepatic resection combined with pancreatoduodenectomy for advanced gallbladder carcinoma, modes of spread of advanced gallbladder carcinoma, results of surgical treatment for advanced gallbladder carcinoma

Reprint requests
Fujio Hanyu Department of Gastroenterological Surgery, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
October 9, 1991

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