An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center.
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.
Dixon
Elijah
E
Hepatobiliary and Pancreatic Surgery, University of Toronto, Toronto, Ontario, Canada.
Vollmer
Charles M
CM
Sahajpal
Ajay
A
Cattral
Mark
M
Grant
David
D
Doig
Christopher
C
Hemming
Al
A
Taylor
Bryce
B
Langer
Bernard
B
Greig
Paul
P
Gallinger
Steven
S
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
Ann Surg Oncol. 2000 Jan-Feb;7(1):55-66
10674450
Hepatogastroenterology. 1999 Jul-Aug;46(28):2114-21
10521952
Ann Surg. 2000 Oct;232(4):557-69
10998654
Adv Surg. 2001;35:1-20
11579805
Br J Surg. 2002 Feb;89(2):179-84
11856130
J Hepatobiliary Pancreat Surg. 2001;8(6):511-7
11956901
World J Surg. 2002 Jul;26(7):867-71
11960212
Ann Surg. 2002 Oct;236(4):397-406; discussion 406-7
12368667
J Gastrointest Surg. 2002 Sep-Oct;6(5):776-80
12399069
Langenbecks Arch Surg. 2002 Oct;387(5-6):222-8
12410358
Surg Oncol Clin N Am. 2002 Oct;11(4):985-94
12607584
Surg Gynecol Obstet. 1978 Dec;147(6):929-42
362580
Surgery. 1985 Oct;98(4):752-9
4049246
Chirurgie. 1986;112(5):337-42
3608701
Nihon Geka Gakkai Zasshi. 1990 Feb;91(2):223-7
2325606
Ann Surg. 1992 Nov;216(5):565-8
1359844
Ann Ital Chir. 1992 Nov-Dec;63(6):693-7
1305370
Arch Surg. 1993 Sep;128(9):1054-6
8368924
Br J Surg. 1994 Jan;81(1):108-10
7906181
Ann Surg. 1994 Mar;219(3):275-80
8147608
Ann Radiol (Paris). 1994;37(5):323-33
7993018
Aust N Z J Surg. 1995 Oct;65(10):724-7
7487712
Surgery. 1996 Nov;120(5):816-21
8909516
Ann Surg. 1996 Nov;224(5):639-46
8916879
Cancer. 1997 Jan 1;79(1):185-6
8988744
Am J Gastroenterol. 1997 Jan;92(1):181-2
8995975
Hepatogastroenterology. 1997 Mar-Apr;44(14):376-7
9164504
Am J Surg. 1997 Jun;173(6):467-71
9207156
Cancer. 1997 Nov 15;80(10):1904-9
9366291
Cancer. 1998 Aug 1;83(3):423-7
9690533
Nihon Geka Gakkai Zasshi. 1998 Oct;99(10):728-32
9866839
Br J Surg. 1999 May;86(5):622-7
10361182
Br J Surg. 1999 May;86(5):685-9
10361195
Ann Surg. 1999 Aug;230(2):266-75
10450742
Ann Surg. 1999 Sep;230(3):309-18; discussion 318-21
10493478
Br J Surg. 2000 Apr;87(4):418-22
10759735