title: Indications for major hepatectomy and combined procedures for advanced gallbladder cancer.
abstract: BACKGROUND
  The clinical impact of major hepatectomy for advanced gallbladder cancer is currently unclear.
  
  
  METHODS
  Patients who underwent resection for stage II, III or IV gallbladder cancer were enrolled. The surgical outcomes of patients who underwent major hepatectomy were compared with those of patients treated with minor hepatectomy and those with unresectable gallbladder cancer. The clinical impact of major hepatectomy and combined advanced procedures such as portal vein resection or pancreatoduodenectomy for advanced gallbladder cancer were evaluated.
  
  
  RESULTS
  A total of 96 patients were enrolled; 29 patients underwent major and 67 had minor hepatectomy. The overall morbidity rate was higher in the major hepatectomy group (55 versus 27 per cent; P = 0·022). There were no deaths after major hepatectomy. Overall survival was better in the major hepatectomy group than in the group of 15 patients with unresectable disease (median survival 17·7 versus 11·4 months; P = 0·003). In a subgroup analysis of the major hepatectomy group, liver metastasis (P = 0·038) and hepatic arterial invasion (P = 0·017) were independently associated with overall survival. Overall survival in patients with liver metastasis (P = 0·572) or hepatic arterial invasion (P = 0·776) was comparable with that in the unresectable group. However, overall survival among patients with lymph node metastasis (P = 0·062) or following portal vein resection (P = 0·054) or pancreatoduodenectomy (P = 0·011) was better than in the unresectable group.
  
  
  CONCLUSIONS
  Major hepatectomy combined with portal vein resection or pancreatoduodenectomy, if necessary, may be considered in the treatment of advanced gallbladder cancer, especially in selected patients without liver metastasis or hepatic arterial invasion.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Ashida
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Okamura
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka 4118777, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Uesaka
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome