[Lymphatic and vascular systems of the gallbladder--with special reference to carcinoma of the gallbladder]

To understand the spreading modes of cancer of the gallbladder concerning its surgical treatment, relation between the infiltration depth of the cancer and the lymph and blood vessel systems in the gallbladder was investigated. Clinico-pathological studies of 23 cases of the gallbladder carcinoma showed that the infiltration depth related to the degree of differentiation, invasiveness to lymph and blood vessel, and the metastasis of lymph nodes. Lymphatic and vascular systems of the gallbladder and bile duct were examined in 22 dogs. The vasculature in the wall of the gallbladder was divided into three layers. The veins at the liver bed were communicated with the intrahepatic portal veins. The lymphatic system in the wall was more clearly shown after obstruction of lymph vessels by ligation of soft tissues in the hepatoduodenal ligament and revealed four layers. The lymph vessels draining from the gallbladder descended along the cystic duct and the bile duct. They passed the portal and pancreatoduodenal lymph nodes and entered the cisterna chyli. In addition, lymph obstruction revealed other lymph tracts to the hepatic parenchyma of the hepatic hilum, retroperitoneum, celiac axis and the splenic vessel regions. The findings suggest that (1) simple cholecystectomy is suitable for the intramucosal carcinoma. (2) for the carcinoma infiltrating to the lamina muscularis, vascular invasion and spreading to the liver through the liver bed of gallbladder is suspected, and (3) for the carcinoma with subserosal infiltration, hepatic segmentectomy with complete resection of the extrahepatic bile duct and removal of the regional lymph nodes of the hepatoduodenal ligament and the vicinity of the gastropancreatic region are required because vascular and lymphatic spreads are suspected. Adjuvant therapy should be required and strict follow up survey should be maintained.