EVALUATION OF IMAGING EXAMINATION FOR HEPATIC INVASION OF CARCINOMA OF THE GALLBLADDER AND POSTOPERATIVE-PATIENT OUTCOME

BACKGROUND: Hepatic invasion is an important factor in the selection o f an operative procedure for patients with carcinoma of the gallbladde r. Imaging modalities to detect the hepatic invasion were evaluated fo r accuracy, and postoperative patient outcome was analyzed. STUDY DESI GN: Thirty-six patients who were treated for carcinoma of the gallblad der at our institution between 1984 and 1993 were studied. The imaging results of ultrasonography (US), computed tomography, and angiography were compared with histologic findings regarding intrahepatic invasio n of the carcinoma. RESULTS: Histologic examination of the operative s pecimens removed from 21 patients revealed that the detection of hepat ic invasion with preoperative US was superior to that with the other t wo modalities. The preoperative US showed a diagnostic value that was almost the same as that of the intraoperative US. The postoperative pa tient outcome was not satisfactory, although extended radical operatio n was performed using image guidance in the 21 patients. The patients died as a result of nodal recurrence rather than hepatic recurrence. C ONCLUSIONS: Preoperative US should be performed initially for detectin g hepatic invasion from carcinoma of the gallbladder and can be substi tuted for intraoperative US. Considering the operative treatment for p atients with carcinoma of the gallbladder, lymph node dissection is as important as the extent of hepatectomy.