Operative Strategy for Gallbladder Carcinoma with Subserosal Invasion from the Viewpoints of the Tumor Spreading Mode and Prognosis

Takayuki Suto, Senji Kanno*, Osamu Funato, Hiroyuki Nitta, Masahiko Murakami, Hidenobu Kawamura, Ryoko Sasaki, Kazuyoshi Saito

Department of Surgery I, School of Medicine, Iwate Medical University
*Department of Surgery, Iwate Prefectural Senmaya Hospital

We investigatd clinicopathological factors and prognosis for the appropriate operation from the viewpoint of the tumor spreading mode for 20 patients who received resections for gallbladder cancer with subserosal invasion (ss cancer). Their 5-year survival rate was 54.4%. There was a significant difference in the survival rate between curative cases and non curative cases (p=0.0035). A significant difference in the survival rate was also observed between node-negative and node-positive patients (p=0.047). Lymph nodal involvement was found in 60% of the patients. The sites of lymph node metastasis were mainly No. 12, 13a, 8. Jumping metastases were found in No. 13a and 8. It was suggested that lymph node dissection of more than R3 and resection of lymphatic vessel in hepatoduodenal ligament and node surrounding the pancreatic head is essential for curative resection. There was recurrence at No. 13a in patients with extended cholecystectomy (Ex-C) with lymph node dissection (R2), and liver metastasis in Ex-C with pancreatoduodenectomy. No operative death or postoperative hepatic failure has been encountered. All of the patients with positive lymph node metastasis who have survived for more than three years after the resection of ss cancer had received medial inferior and anterior inferior hepatectomy (S4 a5) with pylorus preserving pancreaticoduodenectomy (PPPD) and lymph node dissection (R3-ex). Therefore, we concluded that S4a5 with PPPD and lymph node dissection (R3-ex) may be the standard operation for ss cancer except for obvious n4 (+).

Key words
gallbladder cancer with subserosal invasion, hepatopancreatoduodenectomy, surgical treatment for gallbladder cancer

Reprint requests
Takayuki Suto Department of Surgery I, School of Medicine, Iwate Medical University
19-1 Uchimaru, Morioka, 020-8505 JAPAN

Accepted
October 1, 1997

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