title: Long-term results of central inferior (S4a+S5) hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy for gallbladder carcinoma with subserous or mild liver invasion (pT2-3) and nodal involvement: a preliminary report.
abstract: OBJECTIVE
  Gallbladder carcinoma, especially advanced cancer that has invaded the subserosal or deeper layers, has a poor prognosis. Recently, radical operations combining resection of the liver and pancreas with extended lymph node dissection have been introduced to improve the prognosis of advanced gallbladder carcinoma. We have introduced central inferior (Couinaud's subsegments 4a and 5; S4a+S5) hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy for gallbladder carcinoma demonstrating subserous or mild liver invasion (pathological tumor stage pT2-3) and nodal involvement.
  
  
  METHODS
  Morbidity, mortality, clinicopathological features, and long-term outcome were analyzed retrospectively for seven consecutive patients who underwent this radical operation.
  
  
  RESULTS
  The postoperative morbidity rate was 57.1% and there was no surgical mortality. All patients had lymph node involvement: two had pN1 disease and five had pN2 disease. All patients underwent curative resection. Only one patient developed gallbladder carcinoma recurrence after resection and it involved the paraaortic lymph nodes. Five patients, three of whom displayed pN2 disease, survived longer than 5 years postoperatively with no evidence of disease.
  
  
  CONCLUSIONS
  S4a+S5 hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy improve the long-term survival of gallbladder carcinoma with pT2-3 and nodal involvement. The presence of pN2 disease is not a contraindication for surgery. Further study is necessary to evaluate the usefulness of this radical procedure, especially as a standard operation.
authors.affiliation: Department of Surgery I, Iwate Medical University School of Medicine, Morioka, Japan. rsasaki@iwate-med.ac.jp
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sasaki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takeda
authors.forename: Koichi
authors.initials: K
authors.lastname: Hoshikawa
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: Yasunori
authors.initials: Y
authors.lastname: Yaegashi
authors.forename: Senji
authors.initials: S
authors.lastname: Kanno
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000601:surgery; D000368:Aged; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D012704:Serous Membrane / Q000473:pathology; D016896:Treatment Outcome