Rationale of Operative Procedure for Gallbladder Cancer Specially Focused on the Subserosal Invasion

Kohji Miyazaki, Kenji Kitahara, Michito Mori, Satoru Matsuyama and Tomonori Shimonishi

Department of Surgery, Saga University School of Medicine

Purpose: To establish a rational surgical approach to gallbladder cancer which varies widely in dissemination, we analyzed clinicopathologic features based on the depth of invasion. Method: Dissemination in 56 gallbladder cancers and prognosis were clinicopathologically analyzed based on the depth of invasion. For ss (invade to the subserosal layer) gallbladder cancer we further classified subjects into three groups based on the grade of invasion in the subserosal layer of the gallbladder. Results: Five-year survival of the patients with m (invade to the mucosal layer) and mp (to the muscular layer) cancer was 100%. That of those with ss cancer was 80%, with se (expose to the serosa) cancer 34% and with si (invade to the neighbor organ) cancer 13%. Gallbladder cancer with minimum invasion to the subserosal layer (ss min) had clinicopathologic features similar to mp cancer, but those with medium (ss med) or massive (ss mas) invasion to the subserosal layer or deeper (se, si) varied widely in dissemination and high-frequency metastasis. The prognosis of patients with paraaortic lymph node metastasis did not differ either with or without pancreatoduodenectomy. Discussion: For cancers with mp and ss minimum invasion, cholecystectomy without hepatectomy should be sufficient but D2 lymph node dissection may be necessary. When invasion is greater than ss medium, hepatectomy of segments 4a and 5 or more extended hepatectomy together with cholecystectomy, extrahepatic bile duct resection, and D2 with paraaortic lymph node or D3 dissection is recommended. Pancreatoduodenectomy should be restricted to direct invasion to the duodenum without paraaortic lymph node metastasis. For cancers with liver metastasis, Hinf3 or Binf2, 3 radical surgery contributes in a few limited cases. Progress in preoperative refined assessment of invasion depth and establishment of the tailor-made multidisciplinary treatment should also be studied further.

Key words
gallbladder cancer, clinicopathologic feature, surgical procedure, prognosis, strategy

Reprint requests
Kohji Miyazaki Department of Surgery, Saga University School of Medicine
5-1-1 Nabeshima, Saga, 849-8501 JAPAN

Accepted
November 26, 2003

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