The prognosis after curative resection of gallbladder cancer with hilar invasion is similar to that of hilar cholangiocarcinoma.

BACKGROUND/PURPOSE: Gallbladder cancer (GBC) often invades the hepatic hilum and even small tumors can cause obstructive jaundice. Operative intervention for GBC with obstructive jaundice is sometimes not recommended because it is associated with a poor prognosis. However, the extended procedure is recommended for patients with hilar cholangiocarcinoma (HC). We therefore compared the postoperative survival of patients with GBC invading the hepatic hilum with that with HC.

METHODS

Between 1998 and 2008, 27 patients with GBC invasion of the hepatic hilum (hGBC) and 124 with HC underwent surgical resection with curative intent in the Department of Surgical Oncology, Hokkaido University Graduate School of Medicine. This study included patients with GBC without peritoneal dissemination and liver or para-aortic lymph node metastasis. Extended right hemihepatectomy and extrahepatic bile duct resection comprise the treatment of choice for GBC with hilar invasion (hGBC). We aimed to achieve R0 outcomes by aggressive vascular resection and/or concomitant resection of directly invaded organs around the GBC along with extended right hemihepatectomy.

RESULTS

We analyzed 27 patients with hGBC (age 58-83 years; median 71 years; male:female 13:14) and 124 with HC (age 45-80 years; median 69 years; male:female 94:30). The 3- and 5-year survival rates of 43 and 24% for hGBC and 58 and 38% for HC, respectively, did not differ significantly (p = 0.14). Preoperative obstructive jaundice was a complication in 22 (81%) and 95 (77%) patients with hGBC and HC, respectively. The 5-year survival rates were 40 and 36%, respectively, which did not differ significantly (p = 0.61). The 5-year survival rates after extended right hemihepatectomy to resect the tumor with curative intent were 34 and 34% for hGBC and HC, which did not differ significantly (p = 0.14).

CONCLUSIONS

The prognosis after curative resection of GBC with hilar invasion is similar to that of HC in selected patients. Aggressive surgery for advanced GBC with hilar invasion might increase survival rates.