Clinicopathological Rationale of Hepatic Resection for Hepatic Hilar Ductal Carcinoma and Gallbladder Carcinoma

Abstract

This study was aimed to clarify the surgical implication for hepatic resection for hepatic hilar ductal carcinoma and gallbladder carcinoma by clinicopathological examination of surgical specimens. Hepatic Hilar Ductal Carcinoma: Extramucosal extension toward the hepatic side was observed in 14 (78%) of 18 cases. The histological tumor margin was usually identified in the extramural layer, and the left dominant carcinomas had extended toward the left, whereas these right dominant ones had extended toward the right significantly (p<0.05). It was shown retrospectively that a histologically cancer-free surgical margin would be obtained in 89% of the cases if the proximal bile duct was cut at 15 mm proximally beyond carcinoma extension judged by the preoperative PTBD image, and in 72% of the cases if the proximal bile duct was cut at 15 mm proximally beyound mucosal carcinoma extension. Gallbladder Carcinoma: Of 19 cases of advanced gallbladder carcinoma which invaded into or beyound the subserosal layer, 11 hepatic metastases were histologically demonstrated in 6 cases (32%). These included 4 microscopic occult metastases (36%) smaller than 1 mm in diameter. It is suggested that appropriate hepatic resection such as segmentectomies of S4a and S5 and extended right lobectomy might be required in a patient with direct hepatic invasion. This study was aimed at clarifying the necessity for and good degree of hepatectomy of hepatic hilar ductal carcinoma and gallbladder carcinoma by full clinicopathological examination of surgical specimens obtained by hepatic resection.