Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma

BACKGROUND: The prognosis of advanced gallbladder carcinoma (GBCa) remains unfortunate. However, the prognostic factors and the efficacy of extended resection remain unclear. The adequacy for extended resection for T2 and T3 GB Ca, according to the characteristics of either the clinicopathological factors or the prognostic factors, was evaluated. METHODS: A series of 73 patients with GBCa were treated after 1989. Tumor staging from the AJCC revealed 23 patients with T2 tumors, and 29 patients with T3 tumors, respectively. RESULTS: For T2 GB Ca, the patient group of extra-hepatic bile duct resection (BDR) and the patient group of S4a + 5 hepatectomy S4a + 5 had significantly better survival rates. For T3 GB Ca, the patient group of BDR and S4a + 5 tend to have better survival rates. For both T2 and T3 GB Ca, either pancreatoduodenectomy (PD) or pylorus-preserving pancreatoduodenectomy (PpPD) showed no significant difference in survival. CONCLUSION: S4a + 5 combined with BDR and D2 lymph node dissection is a highly recommended operation for the treatment of T2 and T3 GB Ca. Further extension of the operation, such as the addition of PD (PpPD) or an extended hepatectomy, should be carefully modified for each individual according to the cancer spread mode.