Two types of extended liver resection for advanced gallbladder cancer: how to do it.

BACKGROUND Extended liver resection is necessary for advanced gallbladder cancer with hepatic involvement to achieve R0 resection. However, its type or extent and its surgical technique have yet to be established. METHODS To exclude systemic disease, frozen section biopsy following systematic para-aortic lymphadenectomy is recommended before starting extended surgery with curative intent because para-aortic nodes are involved more frequently than expected. Right hepatectomy with biliary reconstruction should be indicated for the hepatic hilum type of advanced gallbladder cancer in which a relatively small tumor in the gallbladder neck infiltrates the hepatic hilum and causes obstructive jaundice. Ventral hepatectomy without biliary reconstruction can be applied for the hepatic bed type in which a large mass in the gallbladder fundus and body penetrates into the hepatic parenchyma through the gallbladder bed. RESULTS The two types of extended liver resection were successfully performed in representative cases. Detailed procedures were described. Long-term survival without disease recurrence has been achieved in both cases. CONCLUSION The type of extended liver resection should be chosen according to the mode of tumor spread in advanced gallbladder cancer without distant metastasis.