Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications?

  • Hideki Nishio
  • Masato Nagino
  • Tomoki Ebata
  • Yukihiro Yokoyama
  • Tsuyoshi Igami
  • Yuji Nimura
Topics: Treatment of patients with advanced gallbladder carcinoma with special reference to stage IV



Advanced gallbladder carcinoma with paraaortic lymph node metastasis or distant metastasis is normally considered a contraindication for surgery. Our latest analyses suggest otherwise.


Records of 166 patients who underwent surgery for stage IV gallbladder carcinoma were reviewed retrospectively. Predictors of hospital mortality and long-term survival were analyzed. Long-term survival in patients with paraaortic lymph node metastasis and/or distant metastasis was also determined.


Fifteen patients were 5-year survivors, with a 5-year survival rate of 12% among the 166 patients investigated. Overall hospital mortality was 14%. Male sex and portal vein resection were independent predictors of hospital mortality. Multivariate analysis of long-term survival failed to identify independent predictors. Patients with distant metastasis were divided into two groups based on whether or not the metastases were distant from the liver. Patients with paraaortic lymph node metastasis who underwent curative resection or who had isolated liver metastasis survived longer than those with other distant metastasis or those with unresectable advanced cancer.


Patients with advanced gallbladder carcinoma can benefit from surgical resection even when paraaortic lymph node metastasis and/or liver metastasis are present. However, surgical indications in advanced disease should be determined on an individual basis, based on clinical status.

Key words

Stage IV gallbladder carcinoma Aggressive surgery Contraindication Paraaortic lymph node metastasis Liver metastasis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Greene, FLPage, DLFleming, IDFritz, AGBalch, CMHaller, DGMorrow, M eds. 2002AJCC cancer staging manual6th edSpringer-VerlagNew York Heidelberg Berlin TokyoGoogle Scholar
  2. 2.
    Sobin, LHWittekind, Ch eds. 2002TNM classification of malignant tumours6th edJohn Wiley & SonsNew YorkGoogle Scholar
  3. 3.
    Japanese Society of Biliary Surgery eds. 2003General rules for surgical and pathological studies on cancer of the biliary tract5th edKaneharaTokyoGoogle Scholar
  4. 4.
    Tsukada, K, Hatakeyama, K, Kurosaki, I, Uchida, K, Shirai, Y, Muto, T, Yoshida, K 1996Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stageSurgery12081621PubMedCrossRefGoogle Scholar
  5. 5.
    Chijiiwa, K, Noshiro, H, Nakano, K, Okido, M, Sugitani, A, Yamaguchi, K, Tanaka, M 2000Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using Western and Japanese classification systemsWorld J Surg2412717PubMedCrossRefGoogle Scholar
  6. 6.
    Kondo, S, Nimura, Y, Hayakawa, N, Kamiya, J, Nagino, M, Uesaka, K 2002Extensive surgery for carcinoma of the gallbladderBr J Surg8917984PubMedGoogle Scholar
  7. 7.
    Wakabayashi, H, Ishimura, K, Hashimoto, N, Otani, T, Kondo, A, Maeta, H 2004Analysis of prognostic factors after surgery for stage III and IV gallbladder cancerEJSO308426PubMedGoogle Scholar
  8. 8.
    Taner, CB, Nagorney, DM, Donohue, JH 2004Surgical treatment of gallbladder cancerJ Gastrointestinal Surg8839CrossRefGoogle Scholar
  9. 9.
    Dixon, E, Vollmer, CM,Jr, Sahajpal, A, Cattral, M, Grant, D, Doig, C,  et al. 2005An aggressive surgical approach leads to improved survival in patients with gallbladder cancer. A 12-year study at a North American centerAnn Surg24138594PubMedCrossRefGoogle Scholar
  10. 10.
    Fong, Y, Wagman, L, Gonen, M, Crawford, J, Reed, W, Swanson, R,  et al. 2006Evidence-based gallbladder cancer staging. Changing cancer staging by analysis of data from the National Cancer DatabaseAnn Surg24376774PubMedCrossRefGoogle Scholar
  11. 11.
    Wakai, T, Shirai, Y, Yokoyama, N, Nagakura, S, Watanabe, H, Hatakeyama, K 2001Early gallbladder carcinoma does not warrant radical resectionBr J Surg886758PubMedCrossRefGoogle Scholar
  12. 12.
    Houry, S, Schlienger, M, Huguier, M, Lacaine, F, Penne, F, Laugier, A 1989Gallbladder carcinoma: role of radiation therapyBr J Surg7644850PubMedCrossRefGoogle Scholar
  13. 13.
    Todoroki, T, Iwasaki, Y, Orii, K, Otsuka, M, Ohara, K, Kawamoto, T, Nakamura, K 1991Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinomaWorld J Surg1535766PubMedCrossRefGoogle Scholar
  14. 14.
    Patt, YZ, Hassan, MM, Aguayo, A, Nooka, AK, Lozano, RD, Curley, SA,  et al. 2004Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinomaCancer10157886PubMedCrossRefGoogle Scholar
  15. 15.
    Kamisawa, T, Tu, Y, Ishiwata, J, Karasawa, K, Matsuda, T, Sasaki, T,  et al. 2005Thermo-chemo-radiotherapy for advanced gallbladder carcinomaHepatogastroenterology52100510PubMedGoogle Scholar
  16. 16.
    Misra, S, Chaturvedi, A, Misra, NC, Sharma, ID 2003Carcinoma of the gallbladderLancet Oncol416776PubMedCrossRefGoogle Scholar
  17. 17.
    Pitt, HA 2005Gallbladder cancer. What is an aggressive approach?Ann Surg24139596PubMedCrossRefGoogle Scholar
  18. 18.
    Kondo, S, Nimura, Y, Hayakawa, N, Kamiya, J, Nagino, M, Uesaka, K 2000Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinomaBr J Surg8741822PubMedCrossRefGoogle Scholar
  19. 19.
    Kondo, S, Nimura, Y, Kamiya, J, Nagino, M, Kanai, M, Uesaka, K,  et al. 2001Five-year survivors after aggressive surgery for stage IV gallbladder cancerJ Hepatobiliary Pancreat Surg85117PubMedCrossRefGoogle Scholar
  20. 20.
    Kondo, S, Nimura, Y, Kamiya, J, Nagino, M, Kanai, M, Uesaka, K, Hayakawa, N 2002Mode of tumor spread and surgical strategy in gallbladder carcinomaLangenbeck's Arch Surg3872228CrossRefGoogle Scholar
  21. 21.
    Nimura, Y, Hayakawa, N, Kamiya, J, Maeda, S, Kondo, S, Yasui, A, Shionoya, S 1991Combined portal vein and live resection for carcinoma of the biliary tractBr J Surg7872731PubMedCrossRefGoogle Scholar
  22. 22.
    Nakamura, S, Suzuki, S, Konno, H, Baba, S, Baba, S 1999Outcome of extensive surgery for TNM stage IV carcinoma of the gallbladderHepatogastroenterology46213843PubMedGoogle Scholar
  23. 23.
    Endo, I, Shimada, H, Fujii, Y, Sugita, M, Masunari, H, Miura, Y,  et al. 2001Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasionJ Hepatobiliary Pancreat Surg850510PubMedCrossRefGoogle Scholar
  24. 24.
    Ishikawa, T, Horimi, T, Shima, Y, Okabayashi, T, Nishioka, Y, Hamada, M,  et al. 2003Evaluation of aggressive surgical treatment for advanced carcinoma of the gallbladderJ Hepatobiliary Pancreat Surg102338PubMedCrossRefGoogle Scholar
  25. 25.
    Miyazaki, M, Itoh, H, Ambiru, S, Shimazu, H, Togawa, A, Gohchi, E,  et al. 1996Radical surgery for advanced gallbladder carcinomaBr J Surg8347881PubMedCrossRefGoogle Scholar
  26. 26.
    Kamiya, S, Nagino, M, Kanazawa, H, Komatsu, S, Mayumi, T, Takagi, K,  et al. 2004The value of bile replacement during external biliary drainage. An analysis of intestinal permeability, integrity, and microfloraAnn Surg23951017PubMedCrossRefGoogle Scholar
  27. 27.
    Nagino, M, Kamiya, J, Arai, T, Nishio, H, Ebata, T, Nimura, Y 2005One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion and outcomeSurgery13714855PubMedCrossRefGoogle Scholar
  28. 28.
    Nagino, M, Kamiya, J, Nishio, H, Ebata, T, Arai, T, Nimura, Y 2006Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer. Surgical outcome and long-term follow-upAnn Surg24336472PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Hideki Nishio
    • 1
  • Masato Nagino
    • 1
  • Tomoki Ebata
    • 1
  • Yukihiro Yokoyama
    • 1
  • Tsuyoshi Igami
    • 1
  • Yuji Nimura
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

Personalised recommendations