Background: Extended cholecystectomy is the common operation for gallbladder carcinoma. When extended cholecystectomy is performed, the liver bed can be generously resected from the fundus to the body of the gallbladder; however, the thickness of the liver parenchyma to be removed is limited to the neck of the gallbladder. There have been few reports providing convincing data with regard to how thick the liver can be anatomically resected by extended cholecystectomy.
Methods: The thickness of the liver tissue actually resected at the time of extended cholecystectomy and that potentially resected by extended cholecystectomy were measured in 24 clinical and 25 autopsy cases, respectively, to assess the anatomical limit of extended cholecystectomy.
Results: The mean anatomical distances from the neck of the gallbladder to the right hepatic duct and to the bifurcation of the anterior and posterior branch of the right hepatic duct were only 1.6 and 5.9 mm, respectively. The distance from the gallbladder to the bifurcation of the superior and inferior branch of the right anterior hepatic duct, and to the root of the right anterior inferior hepatic duct were 11.2 mm2, and 12.8 mm3, respectively (123:p < 0.05). The actual width of the liver excised by extended cholecystectomy was 5.2 mm at the neck, 11.7 mm at the body, and 8.1 mm at the fundus of the gallbladder, respectively. These results indicate that the neck of the gallbladder is anatomically close to the hepatic hilum including the right hepatic duct and portal vein.
Conclusions: Surgical strategy for gallbladder carcinoma should be considered to rely not only upon the depth of invasion but also upon the site of gallbladder tumor. When gallbladder carcinoma involves the muscle layer or further at the neck of the organ, more extensive hepatectomy than extended cholecystectomy should be considered.