title: Does aggressive surgical resection improve the outcome in advanced gallbladder carcinoma?
abstract: OBJECTIVE
  Patients with advanced gallbladder carcinoma have usually been considered nonresectable, leading to a very poor outcome. This study was aimed to evaluate the results of our aggressive surgical approaches in certain cases of advanced gallbladder carcinoma.
  
  
  METHODS
  Ninety-one patients with advanced gallbladder carcinoma of stages pT3 and pT4 who underwent surgery at our institution were the subjects of this study. Fifty-eight of 91 patients had surgical excision; 44 by hepatic resection and 14 by hilar resection. Post-operative outcome was evaluated. Advanced gallbladder carcinomas were classified according to our previously reported classification: type I hepatic; type II biliary; type III hepatobiliary; type IV others.
  
  
  RESULTS
  Curative resection was obtained at a more increased rate in type I tumor patients than in types II and III (91% vs. 29%, p < 0.01). The surgical mortality rate was 17%. Survival rates of resected patients were significantly higher that those of nonresected patients: 45%, 31%, 22%, 17%, 13% at 1, 2, 3, 4, 5 years vs. 9%, 9%, 0% at 1, 2, 3 years (p < 0.01). Survival rates of type I tumor patients after curative resection were remarkably higher than those of type II and III tumor patients, (69%, 64%, 56%, 48%, 39% at 1, 2, 3, 4, 5 years vs. 17%, 17%, 0% at 1, 2, 3 years).
  
  
  CONCLUSIONS
  Aggressive surgical approaches might bring about improved prognosis in advanced gallbladder carcinoma, especially for patients with type I tumors.
authors.affiliation: First Department of Surgery, School of Medicine, Chiba University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Miyazaki
authors.forename: H
authors.initials: H
authors.lastname: Ito
authors.forename: K
authors.initials: K
authors.lastname: Nakagawa
authors.forename: S
authors.initials: S
authors.lastname: Ambiru
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.forename: A
authors.initials: A
authors.lastname: Okuno
authors.forename: S
authors.initials: S
authors.lastname: Nozawa
authors.forename: Y
authors.initials: Y
authors.lastname: Nukui
authors.forename: H
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: S
authors.initials: S
authors.lastname: Furuya
authors.forename: K
authors.initials: K
authors.lastname: Kusashio
authors.forename: N
authors.initials: N
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate