title: Outcome of extensive surgery for TNM stage IV carcinoma of the gallbladder.
abstract: OBJECTIVE
  Whether extensive surgery improves the prognosis of patients with advanced gallbladder carcinoma remains unclear. Twenty-three patients with stage IV carcinoma underwent resection of tumors at our department over a period of 19 years. The outcome of extensive surgery was analyzed in this group.
  
  
  METHODS
  Resection of segments 4a plus 5, extended right lobectomy or right trisegmentectomy, and hepatopancreatoduodenectomy (HPD) were performed in 5 patients, 7 patients, and 11 patients, respectively. Extrahepatic bile duct resection, regional lymph node dissection and paraaortic node dissection were performed in all patients. The survival rate after operation was compared to that of 39 patients with unresectable tumors.
  
  
  RESULTS
  The morbidity rate was high (60.8%), but there were no post-operative deaths. The 1-, 3- and 5-year survival rates were 51%, 17%, and 11%, respectively. The longest survival time of stage IV carcinoma patients was 18 years. The 5-year survival rate of 6 patients undergoing curative resection was significantly better than that of 17 patients undergoing noncurative surgery (p < 0.05). The survival of 11 patients undergoing HPD and 7 patients with para-aortic nodal metastasis were both significantly improved compared to that of patients with unresectable tumors (p < 0.05). The quality of life and the out-of-hospital period were also better.
  
  
  CONCLUSIONS
  Extensive surgery for stage IV gallbladder carcinoma has a good palliative effect.
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Konno
authors.forename: S
authors.initials: S
authors.lastname: Baba
authors.forename: S
authors.initials: S
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D011788:Quality of Life; D015996:Survival Rate