title: Surgical strategy for advanced gallbladder carcinoma according to invasive depth of the tumor.
abstract: OBJECTIVE
  The postoperative survival rate is dependent on the invasive depth of the gallbladder carcinoma. When this carcinoma has invaded beyond the subserosal layer, lymph node and adjacent organ involvement is found in a large number of patients, and long-term survival cannot be achieved. The aim of this study is to establish a surgical strategy for advanced gallbladder carcinoma according to the invasive depth.
  
  
  METHODS
  A retrospective analysis was conducted of 44 patients with the gallblader carcinoma. The invasive depth was histologically defined by the Japanese Society of Biliary Surgery system as follows. (hinf0: within muscle layer, hinf1a: subserosal layer, hinf1b: hepatic infiltration within 5 mm, hinf2.3: hepatic infiltration more than 5 mm)
  
  
  RESULTS
  Wedge resection of the gallbladder bed was performed in 5 cases, and in four of the five patients (80%), intrahepatic recurrence occurred within 6 months. S4a+S5 subsegmentectomy of the liver is performed in 11 cases (hinf0,1a/b:n=5, hinf2,3:n=6) and the postoperative survival rate was significantly better in cases of hinf0,1a/b (p<0.05). In cases of hinf2,3 an extended hepatic lobectomy (n=5) tended to obtain a better survival rate, compared with S4a+S5 subsegmentectomy (n=6)(p=0.13).
  
  
  CONCLUSIONS
  S4a+S5 subsegmentectomy of the liver is a standard operation for GB carcinoma with subserosal invasion.
authors.affiliation: Department of Surgery, The University of Tokushima, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morine
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Satoru
authors.initials: S
authors.lastname: Imura
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fujii
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ikemoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Toru
authors.initials: T
authors.lastname: Utsunomiya
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Kurita
authors.forename: Hidenori
authors.initials: H
authors.lastname: Miyake
authors.forename: Seiki
authors.initials: S
authors.lastname: Tashiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016019:Survival Analysis