A case of gallbladder cancer with para-aortic lymph node metastasis who has survived more than seven years after the primary extended radical operation.

A 55-year-old man with gallbladder cancer was surgically treated in our hospital in July 1988. The tumor was about 8 cm in diameter, replaced the entire gallbladder, and invaded the liver and the hepatoduodenal ligament. In addition, extensive tumor metastasis to lymph nodes, including those of the para-aortic area was noted (Stage IV). Extended cholecystectomy with resection of the liver and lymph node dissection were performed. Although all of the macroscopic tumors were removed surgically, we believed that the tumor would recur in the near future, since all of the excised para-aortic lymph nodes were involved by carcinoma histologically. After surgery, the patient received 5'-deoxy-5-fluorouridine (5'-DFUR) orally at a dose of 600 mg per day. In December 1993, more than 5 years after the primary operation, cancer recurrence in para-aortic lymph nodes was demonstrated by computed tomography (CT). In June 1994, the patient underwent a second operation for treatment of recurrent tumor. The lymph nodes firmly adhered to both the aorta and left renal vein, and could not be removed. Since August 1994, he has received external radiation therapy, and there has been no further enlargement of the nodes. This is the first reported case of gallbladder cancer with para-aortic lymph node metastasis who survived more than seven years after the primary extended radical operation with cholecystectomy, resection of the liver, and extended lymph node dissection.