[Surgical strategy based on the spread mode of gallbladder carcinoma]

Cancer recurs even from early stage of gallbladder cancer if the bile spills over during surgery. The most important point to determine the surgical strategy for gallbladder cancer is the spread mode For pT1b gallbladder cancer, cholecystectomy in the entire layer and regional lymphadenectomy are necessary. Even for pT2 cancer the same surgery is sufficient if the invasion into the subserosal layer is minimal. However, anatomic hepatectomy of S4a + 5 and extrahepatic bile duct resection combined with D2 + paraaortic lymphadenectomy is the fundamental procedure for apparent pT2 or more advanced cancers. If massive direct hepatic invasion is present, central hepatectomy or extended right hepatectomy is indicated. If the right Glissonian triad is involved, right extended hepatectomy is mandatory but the addition of pancreatoduodenectomy must be carefully considered to avoid surgical risk. The presence of liver metasis, jaundice, apparent paraaortic lymph node metastasis, and involvement of the major vessels are not indications for surgery.