Two Types of Extended Liver Resection for Advanced Gallbladder Cancer: How to Do It

Abstract

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.

The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer

“…Gallbladder neck tumors significantly increase surgical difficulty and reduce the opportunities for radical resection. Meanwhile, a relatively small tumor in the gallbladder neck infiltrates the hepatic hilum, thus causing obstructive jaundice [26]. In conclusion, advanced GBC with extrahepatic bile duct invasion and/or jaundice is a candidate for resection when R0 resection is achievable.…”

Role of routine 16b1 lymph node biopsy in the management of gallbladder cancer: an analysis

“…and others reported that patients with 16b1 LN metastases had poor survival similar to that in patients with hepatic or peritoneal metastases . Hence, although intraoperative biopsy and frozen‐section analysis of the 16b1 node before radical surgery have been proposed by various authors, the impact of routine 16b1 LN biopsy on the surgical management of GBC has not been analysed previously.…”

“…Hence, accurate preoperative assessment of the 16b1 LN is crucial in optimizing the management of patients with GBC. Although the morphological appearance (size >10 mm and heterogeneous internal architecture) of the 16b1 LN on computed tomography (CT) of the abdomen has been reported to be useful in predicting metastatic involvement in some studies, others have not found these factors to be good predictors of metastatic disease . Given the poor positive predictive value of cross‐sectional imaging for detection of 16b1 LNs, intraoperative biopsy and frozen‐section analysis of these nodes have been proposed .…”