Cholecystectomy, liver resection, and pylorus-preserving pancreaticoduodenectomy for gallbladder cancer: report of five cases.

Carcinoma of the gallbladder is an uncommon yet highly malignant disease with a poor overall prognosis. Surgical resection offers the only hope for cure in patients with this type of cancer, but resection is often impossible because of advanced disease at the time of presentation. Patients with locally advanced gallbladder cancer, however, may occasionally be amenable to management by adding pancreaticoduodenectomy to cholecystectomy and liver resection. A retrospective review of patient records at the Johns Hopkins Hospital identified five patients with gallbladder cancer with peripancreatic lymph node involvement, who were treated by surgical resection including pancreaticoduodenectomy. The preoperative evaluation, operative technique, pathologic findings, and outcome were reviewed for each patient. Follow-up was obtained via clinic visit or telephone contact. All five patients underwent resection of the gallbladder cancer with an operation that included pylorus-preserving pancreaticoduodenectomy to remove the peripancreatic lymph nodes. In addition, four of the five patients underwent a nonanatomic liver resection. There were no in-hospital deaths. Two patients had postoperative complications; one had persistent drainage from a T-tube site and one had an anastomotic leak from the hepaticojejunostomy. Four patients have died of recurrent tumor during follow-up at intervals ranging from 11 months to 23 months. The fifth patient is alive and free of clinical disease at 42 months after operation. Carcinoma of the gallbladder is a highly malignant disease that is often not amenable to surgical cure. There is a select group of patients, however, in whom adding a pylorus-preserving pancreaticoduodenectomy can result in a potentially curative operation by removing extensive regional spread to the peripancreatic lymph nodes.