title: Hepatopancreatoduodenectomy with wide lymph node dissection for locally advanced carcinoma of the gallbladder--long-term results.
abstract: OBJECTIVE
  Although hepatopancreatoduodenectomy with wide lymph node dissection has been conducted for patients with locally advanced gallbladder carcinoma, the clinical usefulness of this radical procedure has not yet been estimated.
  
  
  METHODS
  Morbidity, mortality, and outcome were analyzed retrospectively for 16 consecutive patients undergoing hepatopancreatoduodenectomy.
  
  
  RESULTS
  One in-hospital fatality (6.3%) and 11 postoperative complications occurred (69%). Overall 5-year survival in this procedure was 42.9%. The 5-year survival of patients undergoing potentially curative resection (52.7%) was significantly better (P = 0.016) than those with residual tumor (0%). There was no significant correlation in 5-year survival between patients with and without lymph node metastasis. Five patients (31%) survived 5 years. Of these, 4 had Stage IVB disease, and 2 had pN2 disease. Two patients with pM1 (lymph) disease died of the disease 6 months and the other 7 months after surgery, respectively.
  
  
  CONCLUSIONS
  Hepatopancreatoduodenectomy with wide lymph node dissection is an effective treatment for the selected patients with locally advanced gallbladder carcinoma with until pN2 disease, if curative resection is potentially feasible. Surgery is not indicated in those with pM1 (lymph) disease.
authors.affiliation: Department of Surgery I, Iwate Medical University School of Medicine, Department of Surgery, Iwate Prefectural Senmaya Hospital, Morioka, Japan. rsasaki@iwate-med.ac.jp
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Funato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murakami
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Kawamura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Suto
authors.forename: Senji
authors.initials: S
authors.lastname: Kanno
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D015996:Survival Rate; D016896:Treatment Outcome