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Published in: World Journal of Surgery 1/2007

01-01-2007

Impact of Tumor Spread to the Cystic Duct on the Prognosis of Patients with Gallbladder Carcinoma

Authors: Takenari Nakata, MD, Akira Kobayashi, MD, Shiro Miwa, MD, Junpei Soeda, MD, Shinichi Miyagawa, MD

Published in: World Journal of Surgery | Issue 1/2007

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Abstract

Introduction

The importance of gallbladder carcinoma spread to the cystic duct has not yet been described. Although the cystic duct is contiguous with the gallbladder, it is located in the hepatoduodenal ligament and differs in structure from the gallbladder. The incidence and prognostic significance of cancer spread to the cystic duct in patients with gallbladder cancer is unclear.

Methods

Surgical specimens from 42 patients who underwent resection for advanced gallbladder carcinoma were examined retrospectively.

Results

Altogether, 13 (31%) of the patients had cancer spread to the cystic duct. The incidences of perineural invasion, lymph node metastasis, and venous invasion were significantly higher in these patients than in the other 29 patients without cancer spread to the cystic duct (P = 0.027, 0.034, and 0.034, respectively). The 3- and 5-year survival rates of these 13 patients were significantly lower than those of the other 29 patients (15.4% vs. 51.0% and 7.7% vs. 46.6%, respectively, P < 0.0001 each). Multivariate analysis using the Cox proportional hazard model identified positive cancer spread to the cystic duct and depth of invasion (beyond serosa) as significant independent indicators of a poor prognosis.

Conclusions

Cancer spread to the cystic duct is an indicator of poor prognosis in patients with gallbladder carcinoma. This may be due to the high incidence of concomitant perineural invasion and lymph node metastasis associated with cancer spread.
Literature
1.
go back to reference Nimura Y, Kamiya J, Kondo S, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 2000;7:155PubMedCrossRef Nimura Y, Kamiya J, Kondo S, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 2000;7:155PubMedCrossRef
2.
go back to reference Chijiiwa K, Nakano K, Ueda J, et al. Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 2001;192:600PubMedCrossRef Chijiiwa K, Nakano K, Ueda J, et al. Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 2001;192:600PubMedCrossRef
3.
go back to reference Miyazaki M, Itoh H, Ambiru S, et al. Radical surgery for advanced gallbladder carcinoma. Br J Surg 1996;83:478PubMed Miyazaki M, Itoh H, Ambiru S, et al. Radical surgery for advanced gallbladder carcinoma. Br J Surg 1996;83:478PubMed
4.
go back to reference Kosuge T, Sano K, Shimada K, et al. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology 1999;46:2133PubMed Kosuge T, Sano K, Shimada K, et al. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology 1999;46:2133PubMed
5.
go back to reference Endo I, Shimada H, Fujii Y, et al. Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasion. J Hepatobiliary Pancreat Surg 2001;8:505PubMedCrossRef Endo I, Shimada H, Fujii Y, et al. Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasion. J Hepatobiliary Pancreat Surg 2001;8:505PubMedCrossRef
6.
go back to reference Kondo S, Nimura Y, Kamiya J, et al. Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg 2002;387:222PubMedCrossRef Kondo S, Nimura Y, Kamiya J, et al. Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg 2002;387:222PubMedCrossRef
7.
go back to reference Yoshikawa T, Ohta T, Araida T, et al. Indications for and operative outcome of hepato-pancreatoduodenectomy in the treatment of carcinoma of the gallbladder (in Japanese with English abstract). J Jpn Surg Soc 1998;99:717 Yoshikawa T, Ohta T, Araida T, et al. Indications for and operative outcome of hepato-pancreatoduodenectomy in the treatment of carcinoma of the gallbladder (in Japanese with English abstract). J Jpn Surg Soc 1998;99:717
8.
go back to reference Japanese Society of Biliary Surgery. General rules for surgical and pathological studies on cancer of biliary tract, 5th edition. Tokyo, Kanehara, 2003 Japanese Society of Biliary Surgery. General rules for surgical and pathological studies on cancer of biliary tract, 5th edition. Tokyo, Kanehara, 2003
9.
go back to reference Kaneoka Y, Yamaguchi A, Isogai M, et al. Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg 2003;27:260PubMedCrossRef Kaneoka Y, Yamaguchi A, Isogai M, et al. Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg 2003;27:260PubMedCrossRef
10.
go back to reference Shimada H, Endo I, Fujii Y, et al. Appraisal of surgical resection of gallbladder cancer with special reference to lymph node dissection. Langenbecks Arch Surg 2000;385:509PubMedCrossRef Shimada H, Endo I, Fujii Y, et al. Appraisal of surgical resection of gallbladder cancer with special reference to lymph node dissection. Langenbecks Arch Surg 2000;385:509PubMedCrossRef
11.
go back to reference Sobin LH, Wittekind CH, editors. International Union Against Cancer: TNM Classification of Malignant Tumors. 6th edition. New York, Wiley-Liss, 2002 Sobin LH, Wittekind CH, editors. International Union Against Cancer: TNM Classification of Malignant Tumors. 6th edition. New York, Wiley-Liss, 2002
12.
go back to reference Ozden I, Kamiya J, Nagino M, et al. Cystic duct carcinoma: a proposal for a new “working definition.” Langenbecks Arch Surg 2003;387:337PubMed Ozden I, Kamiya J, Nagino M, et al. Cystic duct carcinoma: a proposal for a new “working definition.” Langenbecks Arch Surg 2003;387:337PubMed
13.
go back to reference Elnemr A, Ohta T, Kayahara M, et al. Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer. Hepatogastroenterology 2001;48:382PubMed Elnemr A, Ohta T, Kayahara M, et al. Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer. Hepatogastroenterology 2001;48:382PubMed
14.
go back to reference Tanaka K, Ikoma A, Hamada N, et al. Biliary tract cancer accompanied by anomalous junction of pancreaticobiliary ductal system in adults. Am J Surg 1998;175:218PubMedCrossRef Tanaka K, Ikoma A, Hamada N, et al. Biliary tract cancer accompanied by anomalous junction of pancreaticobiliary ductal system in adults. Am J Surg 1998;175:218PubMedCrossRef
15.
go back to reference Shimizu Y, Ohtsuka M, Ito H, et al. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2004;136:1012PubMedCrossRef Shimizu Y, Ohtsuka M, Ito H, et al. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2004;136:1012PubMedCrossRef
16.
go back to reference Anderson JE. Vagus nerves within the abdomen. In: Grant’s Atlas of Anatomy, 8th edition. Baltimore, Williams & Wilkins, 1983, pp 2–115 Anderson JE. Vagus nerves within the abdomen. In: Grant’s Atlas of Anatomy, 8th edition. Baltimore, Williams & Wilkins, 1983, pp 2–115
17.
go back to reference Sato T, Ito M, Sakamoto H, et al. Regional anatomy of vessels and autonomic nerves of gallbladder. Gastroenterol Surg 1999;22:19–29 (in Japanese) Sato T, Ito M, Sakamoto H, et al. Regional anatomy of vessels and autonomic nerves of gallbladder. Gastroenterol Surg 1999;22:19–29 (in Japanese)
18.
go back to reference Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathological studies on perineural invasion of bile duct carcinoma. Ann Surg 1992;215:344PubMedCrossRef Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathological studies on perineural invasion of bile duct carcinoma. Ann Surg 1992;215:344PubMedCrossRef
19.
go back to reference Ogura Y, Takahashi K, Tabata M, et al. Clinicopathological study on carcinoma of the extrahepatic bile duct with special focus on cancer invasion on the surgical margins. World J Surg 1994;18:778PubMedCrossRef Ogura Y, Takahashi K, Tabata M, et al. Clinicopathological study on carcinoma of the extrahepatic bile duct with special focus on cancer invasion on the surgical margins. World J Surg 1994;18:778PubMedCrossRef
20.
go back to reference Seyama Y, Kubota K, Sano K, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 2003;238:73PubMedCrossRef Seyama Y, Kubota K, Sano K, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 2003;238:73PubMedCrossRef
21.
go back to reference Yamaguchi R, Nagino M, Oda K, et al. Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma. Br J Surg 2002;89:1130PubMedCrossRef Yamaguchi R, Nagino M, Oda K, et al. Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma. Br J Surg 2002;89:1130PubMedCrossRef
22.
go back to reference He P, Shi JS, Chen WK, et al. Multivariate statistical analysis of clinicopathologic factors influencing survival of patients with bile duct carcinoma. World J Gastroenterol 2002;8:943PubMed He P, Shi JS, Chen WK, et al. Multivariate statistical analysis of clinicopathologic factors influencing survival of patients with bile duct carcinoma. World J Gastroenterol 2002;8:943PubMed
23.
go back to reference Chijiiwa K, Yamaguchi K, Tanaka M. Clinicopathologic differences between long-term and short-term postoperative survivors with advanced gallbladder carcinoma. World J Surg 1997;21:98PubMedCrossRef Chijiiwa K, Yamaguchi K, Tanaka M. Clinicopathologic differences between long-term and short-term postoperative survivors with advanced gallbladder carcinoma. World J Surg 1997;21:98PubMedCrossRef
24.
go back to reference Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80:661PubMedCrossRef Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer 1997;80:661PubMedCrossRef
25.
go back to reference Fahim RB, McDonald JR, Richards JC, et al. Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg 1962;156:114PubMedCrossRef Fahim RB, McDonald JR, Richards JC, et al. Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg 1962;156:114PubMedCrossRef
26.
go back to reference Ito M, Mishima Y. Lymphatic drainage of gallbladder. J Hepatobiliary Pancreat Surg 1994;1:302CrossRef Ito M, Mishima Y. Lymphatic drainage of gallbladder. J Hepatobiliary Pancreat Surg 1994;1:302CrossRef
27.
go back to reference Shirai Y, Yoshida K, Tsukada K, et al. Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg 1992;79:659PubMed Shirai Y, Yoshida K, Tsukada K, et al. Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg 1992;79:659PubMed
Metadata
Title
Impact of Tumor Spread to the Cystic Duct on the Prognosis of Patients with Gallbladder Carcinoma
Authors
Takenari Nakata, MD
Akira Kobayashi, MD
Shiro Miwa, MD
Junpei Soeda, MD
Shinichi Miyagawa, MD
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 1/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-006-0118-1

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