title: Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long term results.
abstract: BACKGROUND
  The objective of this study was to evaluate the efficacy of combined pancreaticoduodenectomy and hepatectomy for the treatment of patients with locally advanced gallbladder carcinoma.
  
  
  METHODS
  Long term results over 5 years of follow-up were analyzed retrospectively in 17 consecutive patients with gallbladder carcinoma who underwent combined pancreaticoduodenectomy and hepatectomy with radical lymphadenectomy. The indications for pancreaticoduodenectomy were direct invasion of the adjacent organs (stomach, duodenum, or pancreas) and/or the presence of peripancreatic (head only) lymph node metastases. The hepatectomy performed was a nonanatomic resection of the gallbladder bed in 15 patients and an extended right hepatectomy in 2 patients. There was 1 in-hospital death (6%).
  
  
  RESULTS
  Overall, 5 patients (29%) survived 5 years after surgery. Of these patients, four had Stage IVB disease with positive peripancreatic lymph nodes. Eight of the 10 patients who underwent a potentially curative resection survived longer than 3 years, whereas none of the 7 patients with residual tumor survived beyond 15 months. The 5-year survival of 50% (median survival: 58.5 months) in those undergoing a potentially curative resection was significantly better than the 5-year survival of 0% (median survival: 8 months) observed in those patients with residual tumor (P = 0.00086).
  
  
  CONCLUSIONS
  Combined pancreaticoduodenectomy and hepatectomy is an efficacious treatment for patients with locally advanced gallbladder carcinoma, but only if a potentially curative resection is feasible. The presence of peripancreatic (head only) lymph node disease is not a contraindication for this procedure.
authors.affiliation: Department of Surgery, Niigata University School of Medicine, Niigata City, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shirai
authors.forename: T
authors.initials: T
authors.lastname: Ohtani
authors.forename: K
authors.initials: K
authors.lastname: Tsukada
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome