Radical surgery for advanced gallbladder carcinoma

Abstract

Forty-four patients with advanced gallbladder carcinoma (18 with stage pT3 and 26 with stage pT4 of the Union Internacional Contra la Cancrum classification) were aggressively managed by extended heptatic resection in 33 patients, bile duct resection in 28, pancreaticoduodenectomy in seven, gastrointestinal resection in eleven and portal vein resection and reconstruction in seven. Adjacent organ involvement was classified as follows: type I, hepatic involvement with or without gastrointestinal invasion (Ia, Ib); type II, bile duct involvement with or without gastrointestinal invasion (IIa, IIb); type III, hepatic and bile duct involvement with or without gastrointestinal invasion (IIIa, IIIb); type IV, gastrointestinal involvement without hepatic or bile duct invasion. Fourteen of 15 patients with type I tumours had a curative resection compared with seven of 26 with type III lesions (P < 0.0001). The surgical mortality rate was two of 15 patients with type I tumours, seven of 26 with type III tumours and nine of 44 for the whole group. The long-term survival rate after curative resection was four and two of 23 at 3 and 5 years respectively, significantly better than two and none of 21 at 1 and 2 years after non-curative resection (P < 0.01). The survival rate after curative resection for patients with type I tumours was four and two of 14 at 3 and 5 years respectively, significantly better than for other types (P < 0.05). This classification of advanced gallbladder carcinoma according to involvement of adjacent organs might be helpful in planning surgery for this condition; in particular, type I tumours should be treated by a radical surgical procedure to achieve a favourable outcome.

Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group

“…Moreover, in the same series (8)(9)(10)(11)(12), some jaundiced patients appeared to benefit from surgery in terms of survival following resection: with a mean 3-year survival of 20% and some real survivors at 3 and 5 years (8, 11), results never obtained in the subgroup of non-resected jaundiced patients. In the present series, overall survival was better in resected jaundiced patients than in non-resected jaundiced patients (p=.001) and the 3-year overall survival rates of 19% was comparable to the overall survival of resected patients with pancreatic adenocarcinoma in whom the principle of curative R0 resection has been established.…”

“…In the light of these results, the authors concluded that "These data do not support routine operative exploration of patients with jaundice secondary to gallbladder cancer". However, several series experienced teams did not report such a poor outcome and showed that some jaundiced patients obtained improved survival following resection of GBC (8)(9)(10)(11)(12). A subgroup of jaundiced patients may therefore benefit from resection.…”

Routes of Hepatic Metastasis of Gallbladder Carcinoma

“…Lymph node metastasis within the hepatoduodenal ligament, therefore, may facilitate extensive cancer spread through the liver. Miyazaki et al 12 showed prospects for survival in extensively resected cases with bile duct involvement significantly worse than in cases with direct invasion of the liver. This less favorable outlook for survival owing to earlier recurrence may be attributed to the portal tract spread through the involvement of hepatoduodenal ligament.…”

Current Management of Gallbladder Carcinoma

“…T4 tumors are those that invade the main portal vein or hepatic artery, and those that invade two or more extrahepatic organs or structures. T4 tumors are usually not amenable to surgical resection, or carry substantial morbidity and mortality when approached surgically [22].…”