title: Should the bile duct be preserved or removed in radical surgery for gallbladder cancer?
abstract: OBJECTIVE
  It is unclear whether resection of the extrahepatic bile duct in radical surgery for gallbladder cancer should be performed when direct infiltration into the hepatoduodenal ligament is absent.
  
  
  METHODS
  The results of radical surgery with or without bile duct resection were compared in 55 patients with gallbladder cancer without direct extension to the hepatoduodenal ligament. Lymph node dissection and combined resection of involved organs were carried out according to the extent of the tumor.
  
  
  RESULTS
  Nodal involvement was present in 43% of patients with tumors more advanced than pT1. Survival rates were similar between patients with or without bile duct resection in stages I-III, while significantly better survival was observed with bile duct resection in stage IV.
  
  
  CONCLUSIONS
  Considering the adverse effect of bilioenteric anastomosis, preservation of the extrahepatic bile duct is recommended in radical surgery for gallbladder cancer when the tumor is less advanced than stage IV and does not extend to the hepatoduodenal ligament.
authors.affiliation: Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kosuge
authors.forename: K
authors.initials: K
authors.lastname: Sano
authors.forename: K
authors.initials: K
authors.lastname: Shimada
authors.forename: J
authors.initials: J
authors.lastname: Yamamoto
authors.forename: S
authors.initials: S
authors.lastname: Yamasaki
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D015996:Survival Rate