Abstract
There are several important characteristics of the gallbladder from the view of surgical pathology and anatomy. These are the facts of no existence of the muscularis mucosa, the thin and rough proper muscle, existence of the Rokitansky-Aschoff sinus, the attachment of the liver, existence of the neck of the gallbladder and cystic duct in the same area as hepatic hilar tissues such as the bile duct, hepatic artery and portal vein surrounded by the same serosa, existence of direct lymphatic vessels from gallbladder to paraaoritc region. These facts may sometimes make complete resection of the advanced gallbladder carcinoma difficult. To investigate the spread and nature of pT2 gallbladder carcinoma with subserosal invasion is important for adequate operation. Generally, partial resection of the liver, dissection of the lymph nodes of the hepatoduodenal ligament, common hepatic artery and posterior aspects of the pancreas is considered to be necessary. However, there are several controversy about the area of resection of the liver as liver bed resection versus S4a and S5 subsegmentectomy, and about necessity of the prophylactic bile duct resection. When the tumor is small and the depth and mass of the invasion in the subserosal portion is short and small, and style of invasion is IINFα or INFβ, there are no invasion of the hepatoduodenal ligament and no lymphatic metastasis by investigation of autopsy cases. Carcinoma of the gallbladder has the nature of easily invading the subserosal region since the gallbladder has no muscularis mucosa, but it is suggested that the invasion of the subserosal region does not necessarily result in the invasion outside of the gallbladder. There are still may problems in the diagnosis and therapeutic strategies for the pT2 gallbladder carcinoma with subserosal invasion. Analysis should be performed from various aspects such as the sites of origin and degree of mass of invasion.
