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Japanese Journal of Clinical Oncology 2005 35(3):134-138; doi:10.1093/jjco/hyi042
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© 2005 Foundation for Promotion of Cancer Research

Surgical Significance of Superficial Cancer Spread in Early Gallbladder Cancer

Hidetoshi Eguchi1, Osamu Ishikawa1, Hiroaki Ohigashi1, Tsutomu Kasugai2, Shigekazu Yokoyama3, Terumasa Yamada1, Yuichiro Doki1, Kohei Murata1, Isao Miyashiro1, Yo Sasaki1 and Shingi Imaoka1

Departments of 1 Surgery and 2 Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka and 3 Department of Surgery, Suita Municipal Hospital, Suita, Osaka, Japan

For reprints and all correspondence: Hidetoshi Eguchi, Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. E-mail: eguti-hi{at}mc.pref.osaka.jp

Received October 16, 2004; accepted January 13, 2005

Background: A considerable percentage of gallbladder cancers are accompanied by superficial cancer spread adjacent to the main tumor, therefore cholecystectomy for early gallbladder cancer must be performed carefully to avoid leaving cancer cells at the surgical margins.

Methods: Thirty-two patients with gallbladder cancer invading no more than perimuscular connective tissue underwent surgical resection at our medical center. After the operation, resected specimens were investigated macroscopically and microscopically to clarify the clinicopathological features and the risk factors of superficial cancer spread.

Results: Sixty-six percent of all cases (21 cases) had superficial cancer spread. Comparison between the cases having superficial cancer spread and the cases without it revealed that the macroscopic morphology of the primary tumor and the depth of cancer invasion in the gallbladder wall were significantly different between the two groups. Furthermore, multivariate analysis indicated that ‘superficial raised type’ in macroscopic morphology was an independent predictive factor for having superficial cancer spread. Superficial cancer spread from the main tumor located in the neck of the gallbladder grows predominantly in the direction of the fundus. More advanced gallbladder cases were accompanied by more extensive superficial spread.

Conclusions: Superficial cancer spread is frequently observed adjacent to the gallbladder cancer, especially in the superficial raised type. A negative margin should be confirmed by intraoperative frozen section histology while performing cholecystectomy.

Key Words: gallbladder cancer • superficial cancer spread • surgical margin • superficial raised type


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