The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete
lymphadenectomy in the treatment of gallbladder
carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder
carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node-positive disease and among them 23.1% had positive para-aortic nodes. Of six node-positive 5-year survivors, five underwent
pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5-year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal
lymph node metastasis at the time of surgery and underwent pancreas-preserving regional
lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2
lymph node metastasis, as long as complete removal of the
cancer can be achieved.
Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when
lymph node metastasis is obvious and the patient is in good condition.