Evaluation of aggressive surgical treatment for advanced carcinoma of the gallbladder.
OBJECTIVE
An aggressive approach is required to resect advanced carcinoma of the gallbladder. Therefore, an extended surgical procedure often brings about a poor surgical outcome. To test whether an aggressive surgical treatment can improve the survival rate for primary advanced carcinoma of the gallbladder, 59 patients with stage IV primary gallbladder carcinoma were studied.


METHODS
Patients were divided into three treatment groups for the survival analysis: group A (resectional surgery, n = 29), group B (low-dose cis-diamminedichloroplatinum-II and 5-fluorouracil therapy, n = 10), and group C (exploratory laparotomy, other treatment modalities, or no treatment, n = 20).


RESULTS
The prognosis of group A patients was significantly better than that of group B (P = 0.018) or group C (P = 0.0009). Furthermore, group A patients were divided into subgroups. The prognosis of patients resected with no distant metastasis (group A1) was significantly better than that of patients resected with distant metastases of the distant lymph nodes and the liver (group A2) (P = 0.0004). Also, there was no significant difference in the survival rate between the patients resected with distant metastasis (group A2) and chemotherapy cases (group B).


CONCLUSIONS
These results indicated that radical surgery should be performed for patients with no distant metastasis, and that chemotherapy might be a useful alternative treatment for patients with distant metastasis in advanced carcinoma of the gallbladder.
Ishikawa
Tadanori
T
Department of Surgery, Kochi Municipal Central Hospital, Sakuraicho, Kochi 780-0821, Japan.
Horimi
Tadashi
T
Shima
Yasuo
Y
Okabayashi
Takahiro
T
Nishioka
Yutaka
Y
Hamada
Madoka
M
Ichikawa
Junichi
J
Tsuji
Atsuhito
A
Takamatsu
Masahiro
M
Morita
Sojiro
S
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002763:Cholecystectomy / Q000379:methods; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D016577:Pancreaticoduodenectomy / Q000379:methods; D016019:Survival Analysis
D000970:Antineoplastic Agents