The role of extended radical procedures in advanced gallbladder cancer

Owing to recent advances in diagnostic and surgical techniques, aggressive operations for advanced gallbladder carcinoma are becoming more safe. However, the role of a radical operation in terms of long-term survival remains controversial. In this study, we reviewed our experience with gallbladder carcinoma and the literature to clarify the present status of this strategy.

So far in our department, we have treated 88 patients with gallbladder carcinoma and resection was performed in 46 of them. Stages, operative procedures, results of pathologic examinations and the outcome of the resected cases were reviewed.

Only 6 of the 46 patients belonged to the early stage (stage I and II in Nevin staging system, or stage I in TNM staging system) and had a good prognosis. Cholecystectomy with regional lymph node resection was performed in 13 patients. In other patients, more radical procedures including adjacent organ resection were performed according to the spread of the cancer. Major hepatectomy and pancreatoduodenectomy were additionally performed on 8 and 6 patients, respectively. Portal vein resection and reconstruction were performed in 3 patients. The survival rate in advanced cases was poor, but we had 5 long-term (more than 4 years) survivors among 40 patients in the advanced stages. Moreover, one patient undergoing a combination of extended right lobectomy of the liver, pancreato-duodenectomy with portal vein resection and extended node resection of the paraaortic nodes, survived for 3 years and 3 months until she died of another disease.

The prognosis is still not good in patients with advanced gallbladder carcinoma even if radical resection is performed. However, a number of our patients who underwent radical surgery survived a long time.