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Title: Radical surgery for gallbladder carcinoma: possibilities of survival.
Author: Principe A, Del Gaudio M, Ercolani G, Golfieri R, Cucchetti A, Pinna AD.
Journal: Hepatogastroenterology; 2006; 53(71):660-4. PubMed ID: 17086863.
Abstract:
BACKGROUND/AIMS: An aggressive surgical approach in the management of gallbladder cancer (GBC) has improved survival significantly in recent years. The aim of this retrospective study is to evaluate the long-term results of surgical treatment of GBC reassessed following the TNM staging system of the AJCC-2002. METHODOLOGY: The present series considers 118 patients with GBC treated between 1982 and 2003. Seventy-four cases (63%) were females and 44 (37%) males; overall age was 63 years (range 38-91). RESULTS: Among the 118 patients with GBC, 35 (36%) underwent radical surgery: 3 pTNM IA [3 cholecystectomy (CT)], 10 IB [3CT, 3 CT + hepatic resection (HR), 4 HR], 3 IIA (3 HR), 7 IIB (3 CT+HR+ bile duct resection (BDR), 3 HR, 1 hepatopancreatoduodenectomy +CT), 10 III [4 CT+HR, 5 extensive HR (eHR), 1 HR+right colectomy+BDR+total gastrectomy], 2 IV (2 eHR). Overall 1-, 3-, 5-year survival was 67%, 46%, 34% respectively for stage IA-IB; 63%,12%, 12% for IIA-IIB; 50%, 30%, 30% for III-IV (p=ns); in particular, 1-, 3-, 5-year survival was 100%, 100%, 100% for T1a; 50%, 50%, 50% for T1b; 70%, 46%, 35% for T2; 50%, 12%, 12% for T3; 54%, 32%, 32% for T4 (p=ns); 1-, 3-, 5-year survival for patients without lymph node involvement was 58%, 44%, 37% and 60%, 15%, 15% for patients with lymph node metastases (p=ns), respectively. CONCLUSIONS: CT seems to be sufficient in T1a GBC patients but inadequate in T1b (stage IA), which requires a more aggressive approach. In stage IIB, III and IV, the presence of lymph-node metastasis is not a contraindication to aggressive surgery.

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