Segment IVa, V Segmentectomy Including the Gallbladder with Resection of the Bile Duct and Lymphadenectomy for Subserosal Cancer of the Gallbladder

Abstract

Although innovations have occurred in surgical and diagnostic techniques, the prognosis for advanced gallbladder carcinoma remains poor. Gallbladder cancer invades to the liver easily, either directly or by metastasizing in the gallbladder bed via the venous or lymphatic routes. The gallbladder veins drain into the intrahepatic portal vein, mostly at P4 and P5.¹ We have reported that the lymphatic route is also important for hepatic metastasis from the gallbladder, especially metastasis to segments V and IVa.² Furthermore, we have experienced recurrent tumor in segment V after resection of the gallbladder bed for gallbladder carcinoma with subserosal invasion (ss-cancer). Therefore, we have adopted hepatic segment V and segment IVa subsegmentec-tomy as the standard operative procedure for gallbladder carcinoma with subserosal or direct invasion into the liver extending for 2 cm or less.