Hepatic resection for T2-3 gallbladder carcinoma: a retrospective analysis of 12 resectable cases

Abstract

Objective: To report on a group of 12 patients with advanced gallbladder adenocarcinoma at a General Hospital and describe the outcomes (surgical morbidity - mortality and long-term survival) following hepatic resection. Methods: The authors present a series of twelve patients with invasive gallbladder adenocarcinoma who underwent hepatic resection at the General Surgery Service of the Hospital de Ensino da Faculdade de Medicina do ABC, in Santo Andre. The study period was from 2001 to 2007. There were twelve hepatic resections, all associated with hilar lymphadenectomy (IVB-V bisegmentectomy = 9 and right trisectionectomy = 3). There were ten women and two men and all patients were Caucasian. The age range was 52 to 72 years. The preoperative symptoms were biliary colic (n = 6), dyspepsia (n = 4), acute cholecystitis (n = 1) and jaundice (n = 1). The diagnosis was made by radiographic images in the preoperative period in seven patients; all of them were confirmed by frozen section during surgery. Five patients submitted to open cholecystectomy (n = 4) and laparoscopic cholecystectomy (n  = 1) had their diagnoses confirmed postoperatively by histological analysis. Rresults: The operative time varied between 180 and 340 minutes. Four patients received transfusions. The blood loss varied between 200 and 2500 ml. The hospital stay varied from 7 to 16 days. There were two major complications in two patients and both were treated conservatively, one biliary leakage and one reversible hepatic failure. There was no mortality. The TNM stage distribution was: T2N0M0 (n = 4), T2N1M0 (n = 2), T3N0M0 (n = 4) and T3N1M0 (n = 2). Only one patient presented affected surgical margin (T3N1M0) and died with both peritoneal and liver recurrence after a 9-month follow-up. Other three patients presented recurrence(13 to 28 months of follow-up) and died. The three-year survival rate was 33.3% (n  = 4). Cconclusion: The radical surgical treatment with hepatectomy plus hilar lymphadenectomy may offer a long term prognosis to localized gallbladder adenocarcinoma with both minimal morbidity and mortality