Anatomic hepatic segment IVB+V resection with or without extrahepatic bile duct resection is usually indicated for T2 and some T3 gallbladder carcinoma. Significance of this procedure is not only the achievement of a negative margin of primary tumor, but also the eradication of occult intrahepatic metastases that are developed through cancer cell spread along the portal tracts. Furthermore, for cases with gallbladder carcinoma involving the right hepatic artery, this procedure could also be applicable as long as there is minimal biliary invasion, although right hemihepatectomy might be usually selected as a surgical procedure. In this case, the right hepatic artery could be resected without reconstruction, since the left hepatic artery supplies hepatic arterial blood flow to the right lobe of the liver via interlober arterial communication.
Anatomic hepatic segment IVB+V resection with extrahepatic bile duct resection comprises: (1) regional lymph node dissection, (2) division of the distal side of the bile duct, (3) determination of the border of segments IVB and V (4) hepatic parenchymal dissection, (5) division of the proximal side of the bile duct, and (6) biliary reconstruction.
Postoperative complications are seen in approximately 25% of patients undergoing this procedure, while mortality is never seen in our experience. The most common complication is intra-abdominal abscess due to a bile leak, which can be treated conservatively in the adequate drainage.
Anatomic hepatic segment IVB+V resection with or without extrahepatic bile duct resection could be performed safely and provides patients the chance of early recovery and the long-term survival.