Indications for and limitations of extended cholecystectomy in the treatment of carcinoma of the gall bladder.

OBJECTIVE

To assess the indications for, and limitations of, extended cholecystectomy in the treatment of carcinoma of the gall bladder. DESIGN. Retrospective study.

SETTING

University hospital, Japan.

SUBJECTS

23 Patients who were operated on for carcinoma of the gall bladder, 1982-92 out of the total of 73 who presented to our department with the disease.

INTERVENTIONS

Extended cholecystectomy with en bloc lymph node dissection with or without resection of the extrahepatic bile duct, or hepatic resection, or pancreaticoduodenectomy, or a combination.

MAIN OUTCOME MEASURES

Outcome related to TNM classification.

RESULTS

7 Patients had stage I or II disease, and their cumulative five year survival rates (including one censored death) were 67% and 100%, respectively; 9 patients had stage III disease and of these 2/4 patients with T3N1 tumours died of their cancer, but the remaining 7 were alive a mean of 58 months later (though there was one censored death). Of the 7 with stage IV disease all but one were dead within 16 months despite more extensive surgery. The cumulative five year survival was 92% in patients with stage I, II and III (except T3N1 tumours).

CONCLUSION

Extended cholecystectomy with or without resection of the extrahepatic bile duct is indicated for patients with stage I, II, or III (except T3N1) tumours of the gall bladder.