• Br J Surg · Feb 2017

    Comparative Study

    Indications for major hepatectomy and combined procedures for advanced gallbladder cancer.

    • Y Yamamoto, T Sugiura, R Ashida, Y Okamura, T Ito, and K Uesaka.
    • Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
    • Br J Surg. 2017 Feb 1; 104 (3): 257-266.

    BackgroundThe clinical impact of major hepatectomy for advanced gallbladder cancer is currently unclear.MethodsPatients who underwent resection for stage II, III or IV gallbladder cancer were enrolled. The surgical outcomes of patients who underwent major hepatectomy were compared with those of patients treated with minor hepatectomy and those with unresectable gallbladder cancer. The clinical impact of major hepatectomy and combined advanced procedures such as portal vein resection or pancreatoduodenectomy for advanced gallbladder cancer were evaluated.ResultsA total of 96 patients were enrolled; 29 patients underwent major and 67 had minor hepatectomy. The overall morbidity rate was higher in the major hepatectomy group (55 versus 27 per cent; P = 0·022). There were no deaths after major hepatectomy. Overall survival was better in the major hepatectomy group than in the group of 15 patients with unresectable disease (median survival 17·7 versus 11·4 months; P = 0·003). In a subgroup analysis of the major hepatectomy group, liver metastasis (P = 0·038) and hepatic arterial invasion (P = 0·017) were independently associated with overall survival. Overall survival in patients with liver metastasis (P = 0·572) or hepatic arterial invasion (P = 0·776) was comparable with that in the unresectable group. However, overall survival among patients with lymph node metastasis (P = 0·062) or following portal vein resection (P = 0·054) or pancreatoduodenectomy (P = 0·011) was better than in the unresectable group.ConclusionMajor hepatectomy combined with portal vein resection or pancreatoduodenectomy, if necessary, may be considered in the treatment of advanced gallbladder cancer, especially in selected patients without liver metastasis or hepatic arterial invasion.© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

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