Abstract
The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node-positive disease and among them 23.1% had positive para-aortic nodes. Of six node-positive 5-year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5-year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas-preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00268-005-0181-z/MediaObjects/268_2005_181_f1.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00268-005-0181-z/MediaObjects/268_2005_181_f2.gif)
Similar content being viewed by others
References
Chijiiwa K, Sumiyoshi K, Nakayama F. Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 1991;15:322–327
Ouchi K, Suzuki M, Saijo S, et al. Do recent advances in diagnosis and operative management improve the outcome of gallbladder carcinoma? Surgery 1993;113:324–329
Donoue JH, Nagorney DM, Grant CS, et al. Carcinoma of the gallbladder: does radical resection improve outcome? Arch Surg 1990;125:237–241
Wanebo HJ, Castle WN, Fechner RE. Is carcinoma of the gallbladder a curative lesion? Ann Surg 1982;195:624–631
Shirai Y, Yoshida K, Tsukada K, et al. Radical surgery for gallbladder carcinoma; long-term results. Ann Surg 1992;216:565–568
Chijiiwa K, Yamaguchi K, Tanaka M. Clinicopathologic differences between long-term and short-term postoperative survivors with advanced gallbladder carcinoma. World J Surg 1997;21:98–102
Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80:661–667
Kondo S, Nimura Y, Hayakawa N, et al. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg 2000;87:418–422
Shimada H, Endo I, Togo S, et al. The role of lymph node dissection in he treatment of gallbladder carcinoma. Cancer 1997;80:661–667
Puhalla H, Wild T, Bareck E, et al. Long-term follow-up of surgically treated gallbladder cancer patients. Eur J Surg Oncol 2002;28:857–863
Taner CB, Nagorney DM, Donohue JH. Surgical treatment of gallbladder cancer. J Gastrointest Surg 2004;8:83–89
Bloechle C, Izbicki JR, Passlick B, et al. Is radical surgery in locally advanced gallbladder carcinoma justified? Am J Gastroenterol 1995;90:2195–2200
Behari A, Sikora SS, Wagholikar GD, et al. Longterm survival after extended resections in patients with gallbladder cancer. J Am Coll Surg 2003;196:82–88
Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 1991;38:170–175
Nakamura S, Nishiyama R, Yokoi Y, et al. Hepatopancreatoduodenectomy for advanced gallbladder carcinoma. Arch Surg 1994;129:625–629
Shirai Y, Ohtani T, Tsukada K, et al. Combined pancreatoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma; long-term results. Cancer 1997;80:1904–1909
Miyagawa S, Makuuchi M, Kawasaki S, et al. Outcome of major hepatectomy with pancreatoduodenectomy for advanced biliary malignancies. World J Surg 1996;20:77–80
Doty JR, Cameron JL, Yeo CJ, et al. Cholecystectomy, liver resection, and pylorus-preserving pancreatoduodenectomy for gallbladder cancer: report of five cases. J Gastrointest Surg 2002;6:776–780
Fleming ID, Cooper JS, Henson DE, et al. (eds). American Joint Committee on Cancer, Cancer Staging Manual, 5th edition, Philadelphia, Lippincott-Raven, 1998;103–108
Japanese Society of Biliary Surgery: General Rules for Surgical and Pathological Studies on Cancer of Biliary Tract, 5th edition, Tokyo, Kanehara, 2003
Kaplan EL, Meier P. Non-parametric estimation from incomplete observations. J Am Statist Assoc 1958;53:457–481
Shirai Y, Yoshida K, Tsukada K, et al. Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg 1992;79:659–662
Shinkai H, Kimura W, Sata N, et al. A case of gallbladder cancer with para-aortic lymph node metastasis who has survived more than seven years after the primary extended radical operation. Hepatogastroenterology 1996;43:1370–1376
Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 1996;224:639–646
Benoist S, Panis Y, Fagniez PL. French University Association for Surgical Research.Long-term results after curative resection for carcinoma of the gallbladder. Am J Surg 1998;175:118–122
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sasaki, R., Itabashi, H., Fujita, T. et al. Significance of Extensive Surgery Including Resection of the Pancreas Head for the Treatment of Gallbladder Cancer—From the Perspective of Mode of Lymph Node Involvement and Surgical Outcome. World J. Surg. 30, 36–42 (2006). https://doi.org/10.1007/s00268-005-0181-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-0181-z