P-0157 Extrahepatic Adjacent Organ Involvement in Gallbladder Carcinoma: An Aggressive Approach Improves Resectability and Outcome !

Abstract

ABSTRACT Introduction Involvement of extrahepatic adjacent organs in gall bladder carcinoma (GBC) is often considered locoregionally advanced disease. While some consider it as a sign of inoperability, others perform an extended radical surgery (like hepatopancreaticoduodenectomy) to achieve Ro resection. Methods The prospectively collected database of GBC patients operated from May 2006 to November 2011 at our Centre was retrospectively analyzed. Patients with extrahepatic adjacent organ involvement requiring synchronous resection of involved viscera were analyzed to determine its impact on curative resection rate and extent of surgery. Results Of the 461 patients taken up for surgery 263 underwent curative resection. Ninety two patients required resection of one (n=43) or more (n=49) adjacent organs. CBD excision was performed in 63 patients for associated jaundice/bile duct involvement (n=44), choledochal cyst (n=11) or to facilitate lymph node clearance (n=8). Patients with gastroduodenal involvement without pancreatic involvement (n=52) underwent duodenal sleeve resection for small area of contact (n=21) or distal gastrectomy with resection of first part of duodenum for wide area of contact (n= 31). Wedge resection of pancreas was performed in five patients with minimal pancreatic involvement. Colonic involvement (n=28) required sleeve/segmental resection of colon in 21 patients and right hemicolectomy in 7 patients. Resection of single adjacent organ improved overall resectability from 37.09% (171/461) to 46.42% (214/461) and addition of more than one adjacent organ resection improved it to 57.04% (263/461). Conclusion An R0 resection could be achieved with limited pancreatoduodenal resection in most cases without a need for pancreatoduodenectomy. Aggressive approach aimed at resection of involved adjacent viscera improves curative resection rate in gallbladder carcinoma and improves survival.