title: Factors influencing postoperative hospital mortality and long-term survival after radical resection for stage IV gallbladder carcinoma.
abstract: Factors influencing postoperative hospital mortality and long-term survival after radical resection of stage IV gallbladder carcinoma remain unclear. The objective of this study was to identify characteristics of patients who are good candidates in terms of surgical risk and long-term survival for radical resection of stage IV gallbladder carcinoma. A retrospective study was made of attempted surgical cure in 72 patients with stage IV gallbladder carcinoma. There were 14 postoperative hospital deaths (19%). Eleven (19%) of the 58 patients discharged from hospital survived for more than 3 years. Multivariate analysis indicated male gender, extended right hepatic lobectomy in a cholestatic liver, and portal vein resection as independent risk factors that correlated with hospital death. Distant metastasis was the sole independent factor that related negatively with long-term survival by multivariate analysis. Subset analysis was performed with combinations of the four independent factors obtained by multivariate analyses. The hospital mortality rate and the 3-year survival rate in the 44 patients without portal vein involvement were 9% and 28%, respectively, and were 3% and 27%, for the 31 women in this group. The highest 3-year survival rate (39%) was observed in the 26 patients without distant metastasis and portal vein involvement, despite a hospital mortality rate of 12%. Better patient selection may improve the outcome of radical surgery for stage IV gallbladder carcinoma. These data may be useful in designing future trials of the surgical treatment of advanced gallbladder carcinoma.
authors.affiliation: First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, 466-8550, Showa-ku, Nagoya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Junichi
authors.initials: J
authors.lastname: Kamiya
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Michio
authors.initials: M
authors.lastname: Kanai
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.forename: Norihiro
authors.initials: N
authors.lastname: Yuasa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Naokazu
authors.initials: N
authors.lastname: Hayakawa
mesh_terms: D000368:Aged; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology