title: Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer?
abstract: BACKGROUND
  The incidence and mode of spread of carcinoma of the gallbladder into the hepatoduodenal ligament have not been well described pathologically for gallbladder carcinoma extending into the subserosa and beyond.
  
  
  METHODS
  Between 1985 and 2002, 50 consecutive patients with gallbladder carcinoma extending into the subserosa or beyond underwent radical surgery, including extrahepatic bile duct resection. Serial sections of specimens of the resected extrahepatic bile ducts were examined to determine the incidence and the pattern of invasion of the hepatoduodenal ligament from the primary cancer.
  
  
  RESULTS
  Invasion of the hepatoduodenal ligament was present in 30 of the 50 specimens. Of these, 9 showed direct extramural spread (type I), 4 showed continuous intramural spread (type II), 5 showed distant spread separated from the primary tumor (type III), and 4 showed spread of cancer cells from metastatic lymph nodes (type IV). The remaining 8 patients had more than 1 type: 1 patient had types I + III; 3 had types I + III + IV; and 4 had types III+IV. Invasion of the hepatoduodenal ligament was present in 24 of 44 patients without preoperative obstructive jaundice and in 2 of 13 patients with stage IB disease. Patients with types II, III, and IV spread into the hepatoduodenal ligament had significantly better survival than those with type I spread.
  
  
  CONCLUSIONS
  Gallbladder carcinoma extending into the subserosa or beyond invades the hepatoduodenal ligament with relatively high frequency. Preoperative diagnosis of this invasion is difficult; therefore, strong consideration should be given to resection of the extrahepatic bile ducts and lymph nodes.
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba 560-8670, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Akira
authors.initials: A
authors.lastname: Togawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D004386:Duodenum / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000453:epidemiology / Q000209:etiology; D008022:Ligaments / Q000473:pathology; D008099:Liver / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis