Skip to main content
SpringerLink
Log in

Appraisal of surgical treatment for pT2 gallbladder carcinomas

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

This retrospective study was designed to appraise the surgical procedures for pT2 gallbladder (GB) carcinomas. Twenty patients with pT2 GB carcinomas underwent surgical resection. Hepatectomy of segments 4b and 5 was performed in 19 patients, and an extended right hepatic lobectomy was performed in 1. The extrahepatic bile duct was preserved in 8 patients in whom the disease was limited to the GB fundus and/or body. Regional lymphadenectomy was performed in 18 patients. A separate radical second operation was performed in 8 patients after cholecystectomy. Final pathological staging was stage IB in 15 patients, IIB in 4, and IV in 1. Overall 5-year survival rate in those 20 patients was 77% without operative deaths. The 5-year survival rate in 5 patients with nodal metastasis and in 8 patients without extrahepatic biliary resection was 80% and 100%, respectively. A separate radical second operation in 8 patients yielded 75% survival after 5 years. Perineural invasion as a prognostic determinant was closely associated with tumor extending to the neck or the cystic duct. Partial hepatectomy, usually with extrahepatic biliary resection and regional lymphadenectomy, was appropriate as a standard radical operation for pT2 GB carcinoma, but preservation of extrahepatic bile duct is advocated for disease limited to the GB fundus and/or body. Radical second operation enhanced the chance for cure in patients with pT2 GB carcinoma.

Résumé

Cette étude rétrospective évalue les procédés chirurgicaux dans le traitement des cancers de la vésicule biliaire pT2. Vingt patients porteurs de tumeur de la vésicule biliaire pT2 ont eu une résection chirurgicale. L’hépatectomie des segments 4b et 5 a été réalisée chez 19 patients et une lobectomie droite étendue chez un. La voie biliaire extrahépatique a pu être préservée chez huit patients lorsque la maladie était limitée au fundus et/ ou au corps de la vésicule. Une lymphadénectomie régionale a été réalisée chez 18 patients. Une intervention radicale a été réalisée chez huit patients à distance de leur cholécystectomie initiale. Le staging anatomopathologique final a été stade « IB » chez 15 patients, stade « I1B » chez quatre, et stade « IV » chez un. Le taux de survie globale à 5 ans chez les 20 patients a été de 77%, sans aucune mortalité opératoire. Les taux de survie à 5 ans chez les cinq patients porteurs de métastases ganglionnaires et chez les huit patients sans résection extrahépatique, ont été, respectivement, de 80% et de 100%. En cas de deuxième intervention radicale, à distance, chez huit patients s’est soldée par une survie à 5 ans de 75%. L’envahissement périneural a été le facteur pronostique déterminant pour les tumeurs s’étendant au col vésiculaire et au canal cystique. L’hépatectomie partielle avec résection extrahépatique et une lymphadénectomie régionale ont été considérées comme l’intervention standard radicale en cas de tumeur pT2 mais la préservation de la voie biliaire extra-hépatique est conseillée en cas de cancer limité au fundus et/ou corps. L’intervention à distance radicale augmente les chances de cure chez le patient porteur de cancer pT2 de la vésicule biliaire.

Resumen

Se efectúa un estudio retrospectivo para averiguar el tratamiento quirúrgico realizado en carcinomas pT2 de vesícula biliar (GB). 20 pacientes con carcinomas pT2 de vesícula biliar (GB) fueron tratados quirúrgicamente. En 19 pacientes se efectuaron hepatectomías de los segmentos 4b y 5 y en 1 una lobectomía hepática derecha ampliada. La vía biliar extrahepática se conservó en 8 pacientes en los que la lesión estaba localizada, exclusivamente, en el fundus o cuerpo de la vesícula biliar. Iinfadenectomía regional se realizó en 18 casos. Fueron reintervenidos con criterios más radicales 8 pacientes tras sufrir una colecistectomía previa. La estadificación registrada fue la siguiente: estadio IB (n = 15) IIB (n = 4) y IV (n = 1 ). En los 20 pacientes la supervivencia global a los 5 años fue del 77%, sin mortalidad intraoperatoria alguna. La tasa de supervivencia a los 5 años en 5 pacientes con nódulos metastásicos y 8 sin resección biliar extrahepática fue del 80% y 100%. Una segunda operación más radical en 8 pacientes proportionó una tasa de supervivencia a los 5 años del 75%. Un factor pronóstico determinante fue la invasión perineural que se asociaba a la extensión del tumor hacia el cuello o al conducto cístico. La hepatectomía parcial generalmente acompañada de resección de la vía biliar extrahepática y linfadenectomía regional parece constituir la técnica quirúrgica estándar para los carcinomas pT2 de vesícula biliar, pero en los cánceres limitados al fundus y cuerpo de la vesícula se puede respetar la vía biliar extrahepática. Una segunda operación más radical, aumenta la posibilidad de curación en pacientes con carcinomas pT2 de vesícula biliar.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fahim RB, McDonald JR, Richards JC, et al. Carcinoma of the gallbladder: a study of its modes of spread. Ann. Surg. 1962;156: 114–124

    Article  PubMed  CAS  Google Scholar 

  2. Nevin JE, Moran TJ, Kay S, et al. Carcinoma of the gallbladder: staging, treatment, and prognosis. Cancer 1976;37:141–148

    Article  PubMed  CAS  Google Scholar 

  3. Morrow CE, Sutherland DER, Florack G, et al. Primary gallbladder carcinoma: significance of subserosal lesions and results of aggressive surgical treatment and adjuvant chemotherapy. Surgery 1983;94:709–713

    PubMed  CAS  Google Scholar 

  4. Nakamura S, Sakaguchi S, Suzuki S, et al. Aggressive surgery for carcinoma of the gallbladder. Surgery 1989;106:467–473

    PubMed  CAS  Google Scholar 

  5. Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann. Surg. 1996;224:639–646

    Article  PubMed  CAS  Google Scholar 

  6. Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80:661–667

    Article  PubMed  CAS  Google Scholar 

  7. Donohue JH, Stewart AK, Menck HR. The national cancer data base report on carcinoma of the gallbladder, 1989–1995. Cancer 1998;83: 2618–2628

    Article  PubMed  CAS  Google Scholar 

  8. Miyazaki M, Ito H, Nakagawa K, et al. Does aggressive surgical resection improve the outcome in advanced gallbladder carcinoma? Hepatogastroenterology 1999;46:2128–2132

    PubMed  CAS  Google Scholar 

  9. Shirai Y, Yoshida K, Tsukada K, et al. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann. Surg. 1992; 215: 326–331

    Article  PubMed  CAS  Google Scholar 

  10. Shirai Y, Yoshida K, Tsukada K, et al. Early carcinoma of the gallbladder. Eur. J. Surg. 1992;158:545–548

    PubMed  CAS  Google Scholar 

  11. Sobin LH, Wittekind C, UICC: TNM Classification of Malignant Tumours, 6th edition.

  12. Japanese Society of Biliary Surgery (JSBS). Classification of Biliary Tract Carcinoma. First English edition. Kanehara & Co., Ltd., Tokyo, 2001.

    Google Scholar 

  13. Sugarbaker PH. En bloc resection of hepatic segments 4B, 5 and 6 by transverse hepatectomy. Surg. Gynecol. Obstet. 1990;170:250–252

    PubMed  CAS  Google Scholar 

  14. Nagakura S, Shirai Y, Yokoyama N, et al. Clinical significance of lymph node micrometastasis in gallbladder carcinoma. Surgery 2001;129:704–713

    Article  PubMed  CAS  Google Scholar 

  15. Shimada H, Endo I, Togo S, et al. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 1997;79:892–899

    Article  PubMed  CAS  Google Scholar 

  16. Nakamura S, Nishiyama R, Yokoi Y, et al. Hepatopancreatoduodenectomy for advanced gallbladder carcinoma. Arch. Surg. 1994;129:625–629

    PubMed  CAS  Google Scholar 

  17. Tsukada K, Hatakeyama K, Kurosaki I, et al. Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery 1996;120:816–822

    Article  PubMed  CAS  Google Scholar 

  18. Kondo S, Nimura Y, Hayakawa N, et al. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br. J. Surg. 2000;87:418–422

    Article  PubMed  CAS  Google Scholar 

  19. Nakamura S, Suzuki S, Sakaguchi T, et al. Outcome of extensive surgery for TNM stage IV carcinoma of the gallbladder. Hepatogastroenterology 1999;46:2138–2146

    PubMed  CAS  Google Scholar 

  20. Ouchi K, Sugawara T, Ono H, et al. Diagnostic capability and rational resectional surgery for early gallbladder cancer. Hepatogastroenterology 1999;46:2138–2146

    Google Scholar 

  21. Chijiiwa K, Nakano K, Ueda J, et al. Surgical treatment of patients with pT2 gallbladder carcinoma invading the subserosal layer. J. Am. Coll. Surg. 2001;192:600–607

    Article  PubMed  CAS  Google Scholar 

  22. Yamaguchi K, Chijiiwa K, Saiki S, et al. Retrospective analysis of 70 operations for gallbladder carcinoma. Br. J. Surg. 1997;84:200–204

    Article  PubMed  CAS  Google Scholar 

  23. Wise PE, Shi YY, Washington MK, et al. Radical resection improves survival for patients with pT2 gallbladder carcinoma. Am. Surg. 2001; 67:1041–1047

    PubMed  CAS  Google Scholar 

  24. Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann. Surg. 2000;232:557–569

    Article  PubMed  CAS  Google Scholar 

  25. Shirai Y, Tsukada K, Ohtani T, et al. Hepatic metastases from carcinoma of the gallbladder. Cancer 1995;75:2063–2068

    Article  PubMed  CAS  Google Scholar 

  26. Ohtsuka M, Miyazaki M, Itoh H, et al. Routes of hepatic metastasis of gallbladder carcinoma. Am. J. Clin. Pathol. 1998;109:62–68

    PubMed  CAS  Google Scholar 

  27. Noie T, Kubota K, Abe H, et al. Proposal on the extent of lymph node dissection for gallbladder carcinoma. Hepatogastroenterology 1999;46: 2122–2127

    PubMed  CAS  Google Scholar 

  28. Kosuge T, Sano K, Shimada K, et al. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology 1999;46:2133–2137

    PubMed  CAS  Google Scholar 

  29. Muratore A, Polastri R, Bouzari H, et al. Radical surgery for gallbladder cancer: a worthwhile operation? Eur. J. Surg. Oncol. 2000;26:160–163

    Article  PubMed  CAS  Google Scholar 

  30. Yokoyama N, Shrai Y, Hatakeyama K. Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody. Cancer 1999;85:1465–1469

    Article  PubMed  CAS  Google Scholar 

  31. Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann. Surg. 1992;215:344–349

    Article  PubMed  CAS  Google Scholar 

  32. Suzuki S, Sakaguchi T, Yokoi Y, et al. Clinicopathological prognostic factors and impact of surgical treatment of mass-forming intrahepatic cholangiocarcinoma. World J. Surg. 2002;26:687–693

    Article  PubMed  Google Scholar 

  33. Chijiiwa K, Ohsato T, Shinohara M, et al. Clinico-pathological findings of asymptomatic intrahepatic cholangiocellular carcinoma: report of two cases and review of the literature. Eur. J. Surg. Oncol. 1996;22:186–188

    Article  PubMed  CAS  Google Scholar 

  34. Z’graggen K, Birrer S, Maurer CA, et al. Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery 1998;124:831–838

    Article  PubMed  Google Scholar 

  35. Suzuki K, Kimura T, Ogawa H. Long-term prognosis of gallbladder cancer diagnosed after laparoscopic cholecystectomy. Surg. Endosc. 2000;14:712–716

    Article  PubMed  CAS  Google Scholar 

  36. Wakai T, Shirai Y, Hatakeyama K. Radical second resection provides survival benefit for patients with pT2 gallbladder carcinoma first discovered after laparoscopic cholecystectomy. World J. Surg. 2002;26: 867–871

    Article  PubMed  Google Scholar 

  37. Paolucci V, Schaeff B, Schneider M, et al. Tumor seeding following laparoscopy: international survey. World J. Surg. 1999;23:989–995

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, 431-3192, Hamamatsu, Japan

    Shohachi Suzuki, Yoshihiro Yokoi, Kiyotaka Kurachi, Keisuke Inaba, Shigeyasu Ota, Masaki Azuma, Hiroyuki Konno & Satoshi Nakamura

  2. Second Department of Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, 431-3192, Hamamatsu, Japan

    Satoshi Baba

Authors
  1. Shohachi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihiro Yokoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyotaka Kurachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keisuke Inaba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shigeyasu Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaki Azuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroyuki Konno
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Satoshi Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Satoshi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shohachi Suzuki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suzuki, S., Yokoi, Y., Kurachi, K. et al. Appraisal of surgical treatment for pT2 gallbladder carcinomas. World J. Surg. 28, 160–165 (2004). https://doi.org/10.1007/s00268-003-7080-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-003-7080-y

Keywords

Search

Navigation