Radical Resection for Adenosquamous Carcinoma of the Gallbladder with Paraaortic Lymph Node Metastasis: Report of a 5-Year Survivor

Jun Sakata, Yoshio Shirai, Toshifumi Wakai, Kazuhiro Kaneko, Masayuki Nagahashi and Katsuyoshi Hatakeyama

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences

Paraaortic lymph node metastasis has a dismal prognosis in patients with gallbladder carcinoma. We report a case of a gallbladder cancer patient with paraaortic nodal disease who survived over 5 years after resection. A 65-year-old man with locally advanced gallbladder cancer underwent radical resection involving cholecystectomy, wedge resection of the gallbladder bed, pancreaticoduodenectomy, and regional and paraaortic lymph node dissection. Histologic examination showed the primary tumor to be adenosquamous carcinoma with four positive lymph nodes, one of which was a dissected paraaortic node. The patient underwent repeat lymphadenectomy for paraaortic nodal recurrence detected by computed tomography 29 months after the initial resection. Some 36 months later, metastasis to soft tissue in the right knee was managed by amputating the right lower limb above the knee and that to the second lumbar vertebra by external-beam radiation. Left supraclavicular nodal disease found 60 months after the initial resection was resected. The man died of multiple pulmonary metastases 77 months after the initial resection. This case and a review of the literature suggest that paraaortic lymph node dissection may provide a survival benefit for selected patients with gallbladder carcinoma.

Key words
gallbladder neoplasms, lymphatic metastasis, paraaortic lymph node metastasis

Reprint requests
Jun Sakata Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
1-757 Asahimachi-dori, Niigata, 951-8510 JAPAN

Accepted
April 25, 2007

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