Central bisegmentectomy of the liver plus caudate lobectomy for carcinoma of the gallbladder.

Central bisegmentectomy of the liver is recommended as a radical surgical procedure for patients with liver-bed gallbladder carcinoma, which tends to directly invade the hepatic parenchyma through the liver bed. In this article, we describe the indications and our surgical techniques for central bisegmentectomy of the liver plus caudate lobectomy for carcinoma of the gallbladder. We employ combined resection of the caudate lobe, because the caudate lobe often becomes involved even in patients with liver-bed carcinoma. Resection of the extrahepatic bile duct is also required to achieve complete lymphadenectomy within the hepatoduodenal ligament, because tumor invasion of the hepatoduodenal ligament is frequently found. Extensive lymphadenectomy around the head of the pancreas together with removal of the para-aortic lymph nodes should be performed in patients with extensive lymph node metastases.