title: Evaluation of aggressive surgical treatment for advanced carcinoma of the gallbladder.
abstract: 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.
authors: Department of Surgery, Kochi Municipal Central Hospital, Sakuraicho, Kochi 780-0821, Japan.
authors: Tadanori
authors: T
authors: Ishikawa
authors: Tadashi
authors: T
authors: Horimi
authors: Yasuo
authors: Y
authors: Shima
authors: Takahiro
authors: T
authors: Okabayashi
authors: Yutaka
authors: Y
authors: Nishioka
authors: Madoka
authors: M
authors: Hamada
authors: Junichi
authors: J
authors: Ichikawa
authors: Atsuhito
authors: A
authors: Tsuji
authors: Masahiro
authors: M
authors: Takamatsu
authors: Sojiro
authors: S
authors: Morita
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents