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Should the extrahepatic bile duct be resected or preserved in R0 radical surgery for advanced gallbladder carcinoma? Results of a Japanese Society of Biliary Surgery Survey: a multicenter study.
[carcinoma of the gallbladder]
We
assessed
the
significance
of
an
extra
bile
duct
resection
by
comparing
the
survival
of
patients
with
advanced
gallbladder
carcinoma
who
had
resected
bile
ducts
with
those
who
had
preserved
bile
ducts
.
A
radical
cholecystectomy
that
includes
extra
bile
duct
resections
has
been
performed
without
any
clear
evidence
of
whether
an
extra
bile
duct
resection
is
preventive
or
curative
.
We
conducted
a
questionnaire
survey
among
clinicians
who
belonged
to
the
114
member
institutions
of
the
Japanese
Society
of
Biliary
Surgery
.
The
questionnaires
included
questions
on
the
preoperative
diagnosis
,
complications
,
treatment
,
and
surgical
treatment
,
resection
procedures
,
surgical
results
,
pathological
and
histological
findings
,
mode
and
site
of
recurrence
,
and
the
need
for
additional
postoperative
treatment
.
A
total
of
4243
patients
who
had
gallbladder
carcinoma
and
were
treated
from
January
1
,
1994
to
December
31
,
2003
were
identified
.
The
838
R
0
patients
with
pT
2
,
pT
3
,
and
pT
4
advanced
carcinoma
of
the
gallbladder
for
which
there
was
no
cancer
invasion
to
the
hepatoduodenal
ligament
or
cystic
duct
in
the
final
analysis
.
The
5
-
year
cumulative
survival
,
postoperative
complications
,
postoperative
lymph
node
metastasis
,
and
local
recurrence
along
the
hepatoduodenal
ligament
were
not
substantially
different
between
the
resected
bile
duct
and
the
preserved
bile
duct
groups
.
Our
retrospective
questionnaire
survey
showed
that
an
extrahepatic
bile
duct
resection
had
no
preventive
value
in
some
patients
with
advanced
gallbladder
carcinoma
in
comparison
to
similar
patients
who
had
no
such
bile
duct
resection
.
An
extrahepatic
bile
duct
resection
may
therefore
be
unnecessary
in
advanced
gallbladder
carcinoma
without
a
direct
infiltration
of
the
hepatoduodenal
ligament
and
the
cystic
duct
.
Diseases
Validation
Diseases presenting
"the cystic duct"
symptom
carcinoma of the gallbladder
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