[Postoperative complications and management in the surgical treatment for advanced gallbladder carcinomas]

Surgical treatment for advanced gallbladder carcinoma must be based on the extent of the cancer. There are various patterns of cancer spread in advanced gallbladder carcinoma. In cases with hepatic involvement, liver bed resection, hepatic segment Iva + V resection, extended right hepatectomy, or right trisegmentectomy can be selected. In cases with biliary involvement, extended right hepatectomy, pancreaticoduodenectomy, or combined vascular resection can be performed. In cases with gastrointestinal involvement, the involved intestine can be resected with cholecystectomy and bile duct resection. Surgical morbidity rates after surgical treatment for advanced gallbladder carcinoma have been reported to be very high at about 50%, and surgical mortality rates are 7-20%. After extended hepatic resection, surgical mortality rates reach to 30-43%. Hepatopancreaticoduodenectomy (HPD) has a high surgical mortality rate of 25-33%, and combined vascular resection also has a high mortality of 13-67%. To decrease these high morbidity and mortality rates, limited hepatic resection and preoperative portal embolization in hepatic resection, two-stage pancreaticoduodenectomy in HPD, and preservation of the hilar plate at bile duct resection in right hepatic artery resection may be useful. Surgical indications and the choice of operative procedures should be very carefully considered in patients with advanced gallbladder carcinoma because of its high surgical morbidity and mortality rates.