[Therapy of gallbladder carcinoma. Experience of a central hospital].
BACKGROUND
There are various options for the treatment of gallbladder carcinoma; however, only radical resection offers a chance for prolonged survival.


METHODS
The aim of this study was to analyze retrospectively patients suffering from gallbladder carcinoma in a central hospital in Austria. From 1986 to 1999, 77 patients were treated in this surgical department. The median age of the patients was 71.3 years.


RESULTS
In 28 patients the cancer was resected and 22 persons underwent palliative surgery. An explorative laparotomy was performed in 16 patients. Eleven patients had no surgical therapy, 10 persons received gemcitabine or a combination chemotherapy regimen consisting of leucoverin, 5-fluorouracil and mitomycin C. The median survival of patients without chemotherapy following radical resection (n = 15) was 10.7 months (one patient with metastatic cancer was excluded) and for patients with tumor remaining margins (n = 8) 3.2 months (P = 0.023). Without chemotherapy the median patient survival following palliative resection (n = 17) and explorative laparotomy (n = 15) was 1.5 months and 2.1 months. The median survival without surgical therapy was 1.6 months. Chemotherapy was administered to four of the resected patients (median survival 16.5 months), in five patients following palliative surgery and in one patient after explorative laparotomy (median survival 4.3 months) (P = 0.034). In a multivariate analysis, tumor resection (P = 0.034) and tumor-free resection margins (P = 0.025) proved to be the most important determinants for patient survival.


CONCLUSIONS
Tumor resection is the most important factor for a prolonged patient survival. Following radical resection in an early tumor stage and combining this approach with an established chemotherapy, patient survival could be increased significantly.
Puhalla
H
H
Chirurgische Abteilung, Allgemeines öffentliches Krankenhaus, Wiener Neustadt, Osterrreich.
Bareck
E
E
Scheithauer
W
W
Ploner
M
M
Stiglbauer
W
W
Depisch
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002763:Cholecystectomy; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D010166:Palliative Care; D011182:Postoperative Care; D012044:Regression Analysis; D016019:Survival Analysis; D013997:Time Factors; D000093542:Gemcitabine
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D016685:Mitomycin; D002955:Leucovorin; D005472:Fluorouracil; D000093542:Gemcitabine