Mode of Spread and Surgical Treatment of Gallbladder Cancer

Naotaka Kadoya, Kohji Konishi, Masahiko Tsuji, Yoshitaka Kuroda, Kazuhisa Yabushita, Takao Taniya, Wataru Fukushima, Hiroyuki Sahara, Fumiyoshi Saitoh, Atsuo Miwa*

Department of Surgery and Pathology*, Toyama Central Prefectural Hospital

To determine the characteristics of spread and the surgical treatment of gallbladder cancer, clinicopathologic findings of 84 patients were investigated in the past 16 years especially from the view point of depth of wall invasion. The rate of resection was 68.4% in the early period, and 97.8% in the late period. Simple cholecystectomy was performed for mucosal cancer and its outcome was better. On the other hand, lymph nodal involvement was shown in 71.0% of the patients with subserosal invasion (ss), and 78.3% of those with serosal invasion (se) and direct invasion to adjacent organs (si). Direct invasion to the liver was found in 31.3% of the patients with ss, 86.7% of those with se and si, and invasion to the hepatoduodenal ligament in 41.4% of the patients with ss, and 89.5% of those with se and si. Thus, ss, se and si cancer displayed various and expansive modes of spread. Five patients with ss invasion survived for more than five years and the five-year survival rate was 16.0% for ss patients, and 31.3% if limited to those with curative resection. But all patients with se and si died within 25 months. Patients with gallbladder cancer who survived for more than five years had received curative resection, had no lymph nodal involvement, or had lymph nodal involvement only in the first barrier along with ss invasion. Segmental hepatectomy and bile duct resection should be performed in addition to cholecystectomy associated with regional lymphadenectomy to obtain better prognosis for advanced gallbladder cancer.

Key words
gallbladder cancer, depth of wall invasion, spread of gallbladder cancer, surgical treatment for advanced gallbladder cancer

Reprint requests
Naotaka Kadoya Department of Surgery, Toyama Central Prefectural Hospital
2-2-78 Nishinagae, Toyama, 930 JAPAN

Accepted
June 17, 1992

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