Background Endoscopic ultrasound (EUS)-guided drainage is widely used to manage

Objective: The aim of this study was to clarify the clinical impact of our departmental policy for advanced gallbladder cancer (GBC) even with obstructive jaundice. Methods: Obstructive jaundice was defined as serum T-bil ≥2.0 mg/dl. Between 1998 and 2008, 112 patients with GBC were scheduled for surgical resection with curative intent. Thirty-six patients were converted to palliative surgery or exploration alone because of advanced disease. After excluding pathological T1 (UICC) patients (n = 11), the remaining 65 patients were divided into 2 groups; jaundiced group (n = 37) and non-jaundiced group (n = 28). Surgical procedures were conducted based on our departmental guidelines concerning each type of infiltration of GBC. Results: Bile duct resection and major hepatectomy were performed more frequently in patients with jaundice. Although patients in jaundiced group had more advanced disease, 5-year overall survival rates of the patients with or without jaundice were 27 vs. 31% (p = 0.742), which was not statistically significant. Conclusions: Aggressive surgery might improve long-term survival in patients with locally advanced GBC even in the condition of obstructive jaundice with no distant metastasis.

The prognosis after curative resection of GBC with hilar invasion is similar to that of HC in selected patients. Aggressive surgery for advanced GBC with hilar invasion might increase survival rates.

Axilla removal was performed from the beginning in the case of (A) by assessing the size and shape for the presence or absence of axillary lymph node metastasis before surgery using MDCT.

Background: Extended liver resection is necessary for advanced gallbladder cancer with hepatic involvement to achieve R0 resection. However, its type or extent and its surgical technique have yet to be established. Methods: To exclude systemic disease, frozen section biopsy following systematic para-aortic lymphadenectomy is recommended before starting extended surgery with curative intent because para-aortic nodes are involved more frequently than expected. Right hepatectomy with biliary reconstruction should be indicated for the hepatic hilum type of advanced gallbladder cancer in which a relatively small tumor in the gallbladder neck infiltrates the hepatic hilum and causes obstructive jaundice. Ventral hepatectomy without biliary reconstruction can be applied for the hepatic bed type in which a large mass in the gallbladder fundus and body penetrates into the hepatic parenchyma through the gallbladder bed. Results: The two types of extended liver resection were successfully performed in representative cases. Detailed procedures were described. Long-term survival without disease recurrence has been achieved in both cases. Conclusion: The type of extended liver resection should be chosen according to the mode of tumor spread in advanced gallbladder cancer without distant metastasis.