J.Jpn. Surg. Soc.. 88(9): 1350-1353, 1987

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Report on the annual meeting

TREATMENT OF PATIENTS WITH ADVANCED CARCINOMA OF THE GALLBLADDER

The records of 60 patients With carcinoma of the gallbladder whose lesions were resected either radically or palliatively were investigated. Cancer was limited to the muscle layer in 8 patients (m in 6 patients, pm in 2 patients) and was advanced beyond the muscle layer in 52 patients (ss in 15 patients, se in 28 patients, si in 9 patients). Lymphnodal metastases, lymphatic and venous permeations were negative in m and pm patients. But those permeations were found at a high rate in those patients whose cancer had spread beyond the muscle layer. The survival rate of 32 patients with radical resection was calculated by the Kaplan-Meier method. The 5-year survival rate was 100％ in m and pm patients, 16％ in ss patients, 30％ in se patients and 0％ in si patients, respectively.
The patients whose lesion had spread beyond the muscle layer showed poor results. So those patients should be treated as advanced cancer cases. Treatment of advanced cancer was discussed based on our experience. If cancer is found to invade beyond the muscle layer, one of the following procedures should be performed after due consideration of lymphnodal and liver involvement and patients risk ; a) cholecystectomy with wedge resection of the gallbladder bed of the liver, resection of the bile duct and regional lymphadenectomy, b) segmentectomy (S4, 5) of the liver combined with pancreatoduodenectomy, or c) extended right lobectomy of the liver combined with pancreatoduodenectomy.

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