Abstract
Purpose : We conducted this study to evaluate the optimal surgical procedure for ss (pT2) advanced carcinoma of the gallbladder without hepatoduodenal ligament invasion.
Methods : Patients included 115 pT2 advanced carcinoma of the gallbladder, and the cumulative survival rates and mode of postoperative recurrence were retrospectively analyzed about preventative extra-hepatic bile duct resection, method of lymph node dissection and preventative hepatic resection.
Result : The most valuable clinico-pathological factor which influenced survival rate was R0 curative resection and the second factor was lymph node metastasis. On surgical procedure, there were no significant differences in survival rate or recurrence form between the groups that underwent preventative extra hepatic bile duct resection and the group preserved extra hepatic bile duct for lymph node dissection. In R0 curative resection, D0-1 dissection of lymph node metastasis was preferable for the patients with negative lymph node and PD was recommended for the patients with positive lymph node metastasis. There were also no significant differences in survival rate or recurrence the form of liver metastasis between the groups that underwent resection of all layer resection, the gallbladder bed, and the group that underwent segmentectomy4a+5.
Conclusion : For pT2 (ss) advanced carcinoma of the gallbladder without hepatoduodenal ligament invasion, R0 curative resection is most preferable for optimal surgical procedures. Neither preventative extra hepatic bile duct resection nor hepatic resection has any evidence for long term survival. PD was recommended for the patients with positive lymph node metastasis.
