Hepatectomy of segment 4a and 5 combined with extra‐hepatic bile duct resection for T2 and T3 gallbladder carcinoma

Abstract

S4a + 5 combined with BDR and D2 lymph node dissection is a highly recommended operation for the treatment of T2 and T3 GB Ca. Further extension of the operation, such as the addition of PD (PpPD) or an extended hepatectomy, should be carefully modified for each individual according to the cancer spread mode.

Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

“…However, radical surgery, such as major hepatectomy or hepatectomy with PD, had no survival benefit. In addition, the importance of S4a5 hepatectomy and BDR for T2 and T3 GBCa has also been previously reported [6] .…”

“…However, the overall 5-year survival rate is 5%-42.3%, even after radical resection of the tumor [1,2,5,6] . The prognosis for patients with early GBCa, defined as pT1a/b lesions, shows a 5-year survival rate of 82%-100% [6][7][8][9] . Due to the anatomical proximity to important organs, surgery for advanced gallbladder cancer requires an aggressive approach.…”

“…Previous reports have shown a second radical resection to be associated with significantly better survival than cholecystectomy alone in pT2 GBCa patients whose cancers were incidentally found after cholecystectomy [15][16][17][18] , whereas, Wakai et al [19] have reported that 40.5% of patients with unapparent pT2 tumors survived > 5 years after cholecystectomy alone. S4a5 hepatectomy combined with extra-hepatic bile duct resection (BDR) and D2 lymph node dissection is a highly recommended operation for the treatment of T2 and T3 GBCa [6] , although, in T2 GBCa, the surgical procedure remains controversial, and there is no standard operation.…”

Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions

“…The optimal therapeutic strategy for GBC invading the subserosa (TNM classification, T2 tumor) remains controversial. Several arguments have been put forward justifying radical surgery, including regional lymphadenectomy with or without bile duct resection, and partial hepatectomy around the gallbladder fossa or S4a+S5 subsegmentectomy in comparison to simple cholecystectomy [20][21][22][23][24][25][26]. Survival benefits of radical procedures for T2 tumors over simple cholecystectomy alone have been described in several reports [23][24][25][26][27][28][29].…”

“…Several arguments have been put forward justifying radical surgery, including regional lymphadenectomy with or without bile duct resection, and partial hepatectomy around the gallbladder fossa or S4a+S5 subsegmentectomy in comparison to simple cholecystectomy [20][21][22][23][24][25][26]. Survival benefits of radical procedures for T2 tumors over simple cholecystectomy alone have been described in several reports [23][24][25][26][27][28][29]. Radical lymphadenectomy is recommended because the rate of LN metastasis in T2 tumors in GBC is quite high (range, 46.1-61.9%) and radical LN dissection improves long-term survival in patients with LN metastasis [24,27,29].…”