Short- and Long-term Surgical Results of Extended Surgery for Widespread Gallbladder Carcinoma.

Background/aim: Hepatectomy with extrahepatic bile duct resection (Hx+EBDR), pancreaticoduodenectomy (PD), and occasionally hepatopancreaticoduodenectomy (HPD) are required for the treatment of advanced gallbladder cancer (GBC). This study aimed to clarify the clinical value of these extended surgeries for GBC.

Patients And Methods: We retrospectively reviewed the medical records of patients who underwent curative resection (Surg-G, n=59), and their survival rates were compared with those of patients with unresectable GBC who underwent chemotherapy (CTx-G, n=63).

Results: We performed PD (n=15), Hx+EBDR (n=37), and HPD (n=7). The postoperative complication and death rates were as follows: PD, 40% and 7%, respectively; Hx+EBDR, 89% and 14%, respectively; and HPD, 57% and 0%, respectively. Concomitant vascular resection (VR) was required in 61% of the patients. The 5-year overall survival rate and median survival time (MST) for Surg-G were 25.1% and 26 months, respectively, whereas those for CTx-G were 4.6% and 14.4 months, respectively. There were no significant differences between the surgical procedures. Patients who underwent VR had similar prognoses (5-year overall survival rate and MST: 14.5% and 22.3 months, respectively) as the patients in CTx-G.

Conclusion: Although extended surgery may be considered for patients with GBC, careful patient selection and new therapeutic strategies are required, especially for those requiring VR.