Standard Radical Operation for Carcinoma of the Gallbladder from the Viewpoint of Tumor Spreading

Abstract

To determine standard resection for advanced gallbladder carcinoma, surgical results of 96 patients were evaluated. All of the patients were classified according to the TNM category. The extended radical cholecystectomy with (standard procedure) or without bile duct resection was used for 60 patients and the extended operation (major hepatectomy and/or pancreatoduodenectomy) was performed in 36. For T3 or T4 tumors the extended procedure was used for 12 out of 26 patients (46%) or 18 of 22 patients (82%). However, the R1 resection was performed in 9 (35%) or 10 (45%) patients. One patient died within 30 days after the operation. The cumulative 5-year survival rates for patients with T2 (N=48), T3 (N=24), and T4 tumors (N=19) were 66%, 27%, and 15%, respectively. The survival curve for patients with T2 tumors was significantly better than those for patients with T3 or T4 tumors. The 5-year survival rate was 31% for patients with T3 or T4 tumors and RO resection. This was significantly better than that for patients after R1 resection (8%). The standard procedure is recommended for patients with T2 tumors. A more extended procedure is needed for performing RO resection for most patients with T3 or T4 tumors.