Modes of Invasion and Treatment of Gallbladder Carcinoma with Subserosal Invasion

Makoto Sasaki, Toshifumi Eto, Tsutomu Tomioka, Tsukasa Tsunoda, Takashi Kanematsu

Second Department of Surgery, Nagasaki University School of Medicine

The records of 31 patients with gallbladder carcinoma with pathological evidence of subserosal invasion who underwent resectional surgery were analyzed to determine their clinicopathological characteristics and to investigate adequate surgical treatment. The mode of subserosal invasion was divided into three types: ssα (expanding type), ssβ (intermediate type), and ssγ (infiltrative type). In 22 patients with ssα, β, the positive rates of histopathological prognostic factors, lymph node metastasis (32%), venous invasion (18%) and perineural invasion (23%) were significantly lower than the 78%, 67% and 67% in 9 patients with ssγ. Consequently a significant difference in the 4-year survival rate was observed between the ssα, β (68%) and the ssγ (23%) patients. Four of the 22 patients with ssα, β and 3 of the 9 with ssγ received noncurative operations. Of 18 curatively operated on patients with ssα, β, 11 are alive, 3 died of local recurrence, and 4 died of unrelated disease. For the 11 surviving patients, cholecystectomy or partial hepatectomy (S5, S4 inferior) accompanied by lymph node dissection was performed. Resection of the extrahepatic bile duct was also performed in 3 and pancreatoduodenectomy for lymph node metastasis in 2, while recurrence was the cause of death of all 6 curatively operated on patients with ssγ. Local recurrence developed in all 6 and distant metastasis in 5 (liver metastasis in 2, brain metastasis in one and peritoneal dissemination in 2). In conclusion, an extended radical operation is needed to improve the surgical results for patients with gallbladder carcinoma with ssα, β invasion, and for patients with ssγ invasion, multidisciplinary therapy should be given after the extended radical operation.

Key words
gallbladder carcinoma with subserosal invasion, mode of subserosal invasion, surgical treatment

Reprint requests
Makoto Sasaki Second Department of Surgery, Nagasaki University School of Medicine
7-1 Sakamoto-cho, Nagasaki, 852 JAPAN

Accepted
November 11, 1992

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