Hapatopancreatoduodenectomy for carcinoma of the gallbladder

Abstract

Twenty-one patients with advanced carcinoma of the gallbladder (stage IV) underwent pancreatoduodenctomy with combined resection of the liver (HPD) from April 1980 to February 1993. The hepatectomy consisted of resection of the gallbladder bed in 13 patients, resection of S4a+5 in 5, and resection of more than two segments in 3. Seven cases showed direct invasion to duodenum or pancreas head. Twelve cases showed major vascular invasion. Resection and reconstruction of portal vein was performed in 3 cases and resection of right hepatic artery was performed in 7 cases. The rate of metastasis to No.12b₂ and No.13a lymph nodes was 57% and 67% of 21 patients, respectively. The rate of curative resection was only 28.6%. The major causes of non-curative resection were lymph node metastasis to n4, and residual cancer invasion into surrounding tissues (ew). All patients died within 2 years. However, the patients performed curative resection and relatively non-curative resection had sginificantly better prognosis than the patients done absolutely non-curative resection.