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Indication of extrahepatic bile duct resection for gallbladder cancer

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Abstract

Purpose

Extrahepatic bile duct (EHBD) resection is performed as part of radical cholecystectomy for gallbladder (GB) cancer. However, the indication for EHBD resection is still controversial. The aim of the present study was to evaluate the prognostic value of this procedure.

Methods

Patients who underwent surgical resection for GB cancer with curative intent were enrolled. We divided GB cancer into two categories based on the tumor location: proximal-type and distal-type tumors. The former refers to tumors involving the neck or cystic duct, while the latter comprises tumors located between the body and fundus.

Results

This study included 80 patients, 40 each with proximal- and distal-type tumors. Proximal tumor location, lymph node metastasis, and a serum carcinoembryonic antigen level > 5.0 ng/mL were independent predictors of poor prognosis. The 5-year survival rates of patients with proximal-type and distal-type tumors were 33.3 and 73.5%, respectively. Patients with proximal-type tumors showed significantly lower rates of R0 resection, more frequently had ≥ 3 metastatic lymph nodes, and exhibited a higher rate of perineural invasion. EHBD resection improved prognoses only in patients with proximal-type tumors but not in those with distal-type tumors. In the former group, EHBD resection significantly reduced the rate of local or regional lymph node recurrence.

Conclusions

Extended cholecystectomy with EHBD resection should be performed for patients with GB cancer involving the neck and cystic duct to reduce local and regional lymph node recurrence and achieve better prognosis.

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Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan

    Hiroshi Kurahara, Kosei Maemura, Yuko Mataki, Masahiko Sakoda, Satoshi Iino, Yota Kawasaki, Shinichiro Mori, Takaaki Arigami, Yuko Kijima & Shoji Natsugoe

  2. Department of Health Sciences, Kagoshima University, Kagoshima, Japan

    Hiroyuki Shinchi

Authors
  1. Hiroshi Kurahara
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  2. Kosei Maemura
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  3. Yuko Mataki
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  4. Masahiko Sakoda
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  5. Satoshi Iino
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  6. Yota Kawasaki
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  7. Shinichiro Mori
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  8. Takaaki Arigami
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  9. Yuko Kijima
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  10. Hiroyuki Shinchi
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  11. Shoji Natsugoe
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Contributions

Hiroshi Kurahara: study conception and design and drafting of manuscript; Kosei Maemura, Yuko Mataki, Yota Kawasaki, Shinichiro Mori, and Takaaki Arigami: acquisition of data; Masahiko Sakoda, Satoshi Iino, and Yuko Kijima: analysis and interpretation of data; and Hiroyuki Shinchi and Shoji Natsugoe: critical revision of manuscript.

Corresponding author

Correspondence to Hiroshi Kurahara.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Kurahara, H., Maemura, K., Mataki, Y. et al. Indication of extrahepatic bile duct resection for gallbladder cancer. Langenbecks Arch Surg 403, 45–51 (2018). https://doi.org/10.1007/s00423-017-1620-7

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  • DOI: https://doi.org/10.1007/s00423-017-1620-7

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