Abstract
We reviewed 29 cases with advanced gallbladder cancer of invasion depth ss or more for the purpose of clarifying significance and problems of dissection for lymph node metastasis and invasion to hepatoduodenal ligament. The pBinf is 0 for the cases with invasion depth ss and development locus to Gf/Gb, therefore lymphadenectomy becomes main purpose of dissection. On the other hand, we require both lymphadenectomy and dissection of hepatoduodenal ligament, because lymph node metastasis is extremely high for cases with invasion depth se or more, and pBinf positive rate is 75% for cases with development locus to Gn/C/B. About lymph node metastatic site and frequency, 12b was 36%, and 13a was 28%, and both frequency was high. Long-term survival more than five years was obtained in the cases that pancreatoduodenectomy was performed for cases more than pN2. On the other hand, for pBinf positive cases, an operation to remove main blood vessels surgically together is necessary for carcinoma loss of dissected tissue margin in hepatoduodenal ligament. However, it is necessary to try for improvement of operative procedure and to consider operative indication to show operation-related death to an extended operation.
