[Significance of resecting the head of the pancreas for the treatment of gallbladder cancer from the perspective of surgical results and mode of lymph node metastasis]

Abstract

The significance of resecting the head of the pancreas was clinicopathologically investigated, predominantly by examining the mode of lymph node metastasis, in patients with gallbladder cancer. Of 60 patients who underwent resection of gallbladder cancer, 24 patients (40.0%) had lymph node metastasis. The breakdown of lymph node metastases was as follows: 12b (24.0%), 16 (21.7%), 13 (17.1%), 8 (12.2%), 12c (12.0%), 12p (8.0%), and 6 (6.3%). Of 45 patients with advanced gallbladder cancer, 14 patients survived more than 5 years after surgery. In the absence of lymph node metastasis, there were some long-term survivors following D0 dissection, gallbladder resection, or liver bed resection. However, all five long-term survivors with lymph node metastasis underwent S4aS5 resection combined with pylorus preserving pancreatoduodenectomy (PPPD) and D3 dissection. Seven patients had number 13 lymph node metastasis, and only two n2 patients who underwent S4aS5 resection combined with PPPD and D3 dissection, survived more than 5 years. There were no long-term survivors with n3 lymph node metastasis. Of the 50 patients who underwent curative resection, 13 patients experienced recurrence: in the liver in six patients, in the peritoneum in four patients, in the lymph nodes in four patients, in the bone in two patients, in the lung in one patient, and local in one patient (including duplicate cases). Of the four patients with lymph node recurrence, two demonstrated number 12 and/or number 13 lymph node metastasis at the time of surgery and underwent bile duct-conserving D2 dissection, although cancer recurred in the head of the pancreas, probably due to recurrence in number 13 lymph node. Extensive resection including resection of the head of the pancreas was therefore effective in patients with up to n2 lymph node metastasis as long as the cancer could be completely sected.