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Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma

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Abstract

From October 1976 to May, 1990, a total of 86 patients with stage IV (TNM) gallbladder cancer were treated at Tsukuba University Hospital. Twenty-seven of the 86 patients underwent tumor resection; 43 patients received palliative surgery. The remaining 16 were too advanced to have surgery. Of 27 patients who had tumor resection, 9 had resection alone, 17 had intraoperative radiation therapy (IORT)±postoperative external radiotherapy (ERT), and 1 had postoperative ERT.

The procedures used were: extended right hepatic lobectomy plus hepaticobiliary resection (HBR) (n=2), hepatic segmentectomy (SIVb, SV) plus HBR (n=9), hepatic segmentectomy (SIV, V, VI) with HBR (n =1), hepatic segmentectomy (SIV, V) plus HBR with pancreaticoduodenectomy (PD) (n=3), PD plus HBR (n=1), cholecystectomy with wedge resection of the gallbladder fossa plus HBR (n=3), and cholecystectomy plus HBR (n=3), and cholecystectomy (n=4). Regional lymph node dissections were performed in every patient and 17 of 27 patients underwent additional resections of adjacent organs such as the stomach, duodenum, colon, and abdominal wall.

A single dose of 20–30 Gy was delivered intraoperatively for 17 patients. A mean total dose of 36.4 Gy (1.8/fraction) was added to IORT for 10 patients.

The three-year cumulative survival rate was 10.1% for resection plus IORT but 0% for resection alone. The longest survivor is alive and well at 3 years and 3 patients are alive 16,13, and 4 months after tumor resection followed by IORT plus ERT.

Résumé

Entre octobre 1976 et mai 1990, 86 patients ayant un cancer de la vésicule de stade IV (TNM) ont été traités à l'hôpital universitaire Tsukuba. Parmi ces 86 patients, 27 ont eu une résection de leur tumeur et 43 une chirurgie palliative. Les 16 autres cancers étaient trop avancés pour être opérés. Sur les 27 patients qui ont eu une résection de leur tumeur, 9 ont eu une résection seule, 17 ont reçu une irradiation peropératoire (IP) avec ou sans une radiothérapie externe postopératoire (REP) et un patient a reçu une REP postopératoire.

Les différents procédés chirurgicaux étaient les suivants: hépatectomie gauche avec résection hépaticocholédocienne (RHC) (n=2), segmentectomie (IVb, V) avec RHC (n=9), segmentectomie (IV, V, VI) with RHC (n=1), segmentectomie (IV, V) avic RHC et duodénopancréatectomie céphalique (DPC) (n=3), DPC et RHC (n=1), cholécystectomie avec résection du lit vésiculaire à la demande et RHC (n=3), cholécystectomie et RHC (n=3), et cholécystectomie (n=4). Une lymphadénectomie régionale a été effectuée chez tous les patients et sur les 27, 17 ont eu une résection étendue aux organes adjacents: estomac, duodénum, côlon et paroi abdominale.

Vingt à 30 Gy ont été administrés en une seule fois en peropératoire chez 17 patients. Une dose moyenne de 36.4 Gy (1.8/fr.) a été ajoutée à l'IP chez 10 patients.

Le taux de survie actuarielle était de 10.1% pour les résections avec IP mais était de 0% pour les résections seules. Le plus vieux survivant est sans maladie à 3 ans et 3 patients sont vivants depuis 16, 13, et 4 mois après résection de la tumeur suivie d'IP et de REP.

Resumen

Ochenta y seis pacientes con cáncer de la vesícula biliar en estado IV (TNM) fueron tratados en el Hospital de la Universidad de Tsukuba entre octubre de 1976 y mayo de 1990; 27 de los 86 fueron sometidos a resección del tumor y 43 a cirugía paliativa, mientras los 16 restantes se encontraron en estado demasiado avannzado para consideración quirúrgica. De los 27 pacientes sometidos a resección del tumor, 9 tuvieron resección solamente, 17 tuvieron irradiación intraoperatoria (TIIOP)±radioterapia extrena postoperatoria (RTE), y uno tuvo RTE postoperatoria.

Los procedimientos operatorios utilizados fueron los siguientes: lobectomía hepática derecha amplia más resección hepaticocoledociana (RHC) (n=2), segmentectomía hepática (SIVb, SV) más RHC (n=9), segmentectomía hepática (SIV, V, VI) con RHC (n=1), segmentectomía hepática (SIV, V) más RHC con pancreaticoduodenectomía (PD) (n=3), PD más RHC (n=1), colecistectomía con resección de la fosa de la vesícula biliar más RHC (n=3), colecistectomía + RHC (n= 3), y colecistecomía (n=4). Se efectuó disección regional de los ganglios linfáticos en todos los pacientes y 17 de 27 pacientes fueron sometidos a la resección adicional de órganos adyacentes taies como el estómago, duodeno, colon, y pared abdominal.

Una dosis única de 20–30 Gy fue administrada intraoperatoriamente en 17 pacientes. Una dosis total promedio de 36.4 Gy (1.8/fr.) fue añadida a la TIIOP en 10 pacientes.

La tasa de sobrevida acumulada a 3 años fue 10.1% para los pacientes con resección y TIIOP, pero fue de 0% para los pacientes con resección solamente. El paciente de mayor sobrevida está bien a 3 años y 3 se encuentran vivos a 16, 13, y 4 meses después de la resección del tumor seguida de TIIOP más RTE.

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Authors and Affiliations

  1. Departments of Surgery and Radiology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan

    Takeshi Todoroki M.D., Yoji Iwasaki M.D., Kazuo Orii M.D., Masaaki Otsuka M.D., Kiyoshi Ohara M.D., Toru Kawamoto M.D. & Kyoichi Nakamura M.D.

  2. Department of Pathology, Institute of Basic Medicine, University of Tsukuba, Ibaraki, Japan

    Takeshi Todoroki M.D., Yoji Iwasaki M.D., Kazuo Orii M.D., Masaaki Otsuka M.D., Kiyoshi Ohara M.D., Toru Kawamoto M.D. & Kyoichi Nakamura M.D.

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  1. Takeshi Todoroki M.D.
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  2. Yoji Iwasaki M.D.
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  3. Kazuo Orii M.D.
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  4. Masaaki Otsuka M.D.
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  5. Kiyoshi Ohara M.D.
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  6. Toru Kawamoto M.D.
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Supported in part by Grant-in-aid for Cancer Research, No. 62-22, Ministry of Health and Welfare, Japan.

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Todoroki, T., Iwasaki, Y., Orii, K. et al. Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma. World J. Surg. 15, 357–366 (1991). https://doi.org/10.1007/BF01658729

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