title: An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center.
abstract: OBJECTIVE
  To determine if an aggressive surgical approach, with an increase in R0 resections, has resulted in improved survival for patients with gallbladder cancer.
  
  
  BACKGROUND
  Many physicians express a relatively nihilistic approach to the treatment of gallbladder cancer; consensus among surgeons regarding the indications for a radical surgical approach has not been reached.
  
  
  METHODS
  A retrospective review of all patients with gallbladder cancer admitted during the past 12 years was conducted. Ninety-nine patients were identified. Cases treated during the 12-year period 1990 to 2002 were divided into 2 time-period (TP) cohorts, those treated in the first 6 years (TP1, N = 35) and those treated in the last 6 years (TP2, N = 64).
  
  
  RESULTS
  Disease stratification by stage and other demographic features were similar in the 2 time periods. An operation with curative intent was performed on 38 patients. Nine (26%) R0 resections were performed in TP1 and 24 (38%) in TP2. The number of liver resections, as well as the frequency of extrahepatic biliary resections, was greater in TP2 (P < 0.04). In both time periods, an R0 resection was associated with improved survival (P < 0.02 TP1, P < 0.0001 TP2). Overall survival of all patients in TP2 was significantly greater than in TP1 (P < 0.03), with a median survival of 9 months in TP1 and 17 months in TP2. The median 5-year survival in TP1 was 7%, and 35% in TP2. The surgical mortality rate for the entire cohort was 2%, with a 49% morbidity rate.
  
  
  CONCLUSIONS
  A margin-negative, R0 resection leads to improved survival in patients with gallbladder cancer.
authors.affiliation: Hepatobiliary and Pancreatic Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.forename: Ajay
authors.initials: A
authors.lastname: Sahajpal
authors.forename: Mark
authors.initials: M
authors.lastname: Cattral
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.forename: Christopher
authors.initials: C
authors.lastname: Doig
authors.forename: Al
authors.initials: A
authors.lastname: Hemming
authors.forename: Bryce
authors.initials: B
authors.lastname: Taylor
authors.forename: Bernard
authors.initials: B
authors.lastname: Langer
authors.forename: Paul
authors.initials: P
authors.lastname: Greig
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate
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