J.Jpn. Surg. Soc.. 91(9): 1237-1240, 1990

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Report on the annual meeting

RESULTS OF EXTENDED SURGERIES FOR FAR ADVANCED GALLBLADDER CARCINOMA

Thirty nine cases with far advanced (Stage IV) gallbladder carcinoma which had undergone radical resection were studied. Major hepatic resection (defined as more than bisegmentectomy) had been performed in 28 cases (72%), pancreatoduodenectomy in 15 cases (38%) and portal vein resection in 12 (31%). Seven cases (18%) resulted in hospital death, although 8 cases (27%) have survived for more than 2 years including 2 five-year, 1 four-year and 4 three-year survivors. Cumulative survival rate of all 39 cases including hospital death are 49% at one-year, 22% at three-year and 14% at five-year.
In the cases without peritoneal seeding and hepatic metastasis, extended lymph node dissection produced the prolongation of their lives in spite of positive paraaortic nodes.
In 25 cases with severe involvement of hepatoduodenal ligament, major hepatic resection with portal vein resection with or without pancreatoduodenectomy (11 cases) brought not only 45% of hospital death rate but also poor prognosis. At the present time, the indication of this procedure should be strictly reconsidered. However, in 9 cases without seeding, hepatic metastasis and positive paraaortic nodes which had undergone other than this procedure, extended surgeries have produced no hospital death and 5 two-year survivors, then cumulative five-year survival rate of 40%.
In conclusion, extended surgeries with more strict indication and further improvement of operative techniques will give better prognosis for far advanced gallbladder carcinoma.

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