Gallbladder cancer with duodenal infiltration: is it still resectable?

To assess the resectability and the long-term survival in patients of gallbladder cancer with duodenal involvement.

Duodenal infiltration in patients of carcinoma gallbladder is generally regarded as a sign of advanced disease and an indicator of unresectable disease.

A total of 252 patients of gallbladder cancer (GBC) who underwent surgery over a 5-year period were studied for duodenal involvement. Patients with duodenal infiltration on per-operative assessment were analyzed for resectability, postoperative morbidity, mortality and disease free survival.

Forty-three patients were detected to have duodenal infiltration on per-operative assessment out of which 17 had unresectable disease (39.54%), whereas the remaining 26 patients underwent R0 resection (61.9%). Of these, nine underwent distal gastrectomy with resection of the first part of the duodenum (34.62%), 16 underwent duodenal sleeve resection (61.54%), and in one patient pancreatoduodenectomy (HPD) (3.85%) was performed. With regard to the extent of liver resection, two underwent extended right hepatectomy, whereas the remaining 24 underwent segment IVB and V resection. Bile duct and adjacent viscera were resected when involved. Of the resected patients, eight underwent bile duct excision, seven had colonic resection, and three had vascular resection and reconstruction. The postoperative morbidity and mortality was 15 (34.9%) and three (6.97%), respectively, in the resected group of patients. The overall actual survival in the resected group was a mean of 15.87 months, median of 14 months (range 3 to 56 months).

Duodenal infiltration is neither an indicator of unresectability nor an indication to perform Hepato-pancreatoduodenectomy (HPD). In most of these patients, an oncologically adequate R0 resection can be performed with either a duodenal sleeve resection or distal gastrectomy with resection of the first part of the duodenum.