title: Radical surgery for gallbladder carcinoma: possibilities of survival.
abstract: OBJECTIVE
  An aggressive surgical approach in the management of gallbladder cancer (GBC) has improved survival significantly in recent years. The aim of this retrospective study is to evaluate the long-term results of surgical treatment of GBC reassessed following the TNM staging system of the AJCC-2002.
  
  
  METHODS
  The present series considers 118 patients with GBC treated between 1982 and 2003. Seventy-four cases (63%) were females and 44 (37%) males; overall age was 63 years (range 38-91).
  
  
  RESULTS
  Among the 118 patients with GBC, 35 (36%) underwent radical surgery: 3 pTNM IA [3 cholecystectomy (CT)], 10 IB [3CT, 3 CT + hepatic resection (HR), 4 HR], 3 IIA (3 HR), 7 IIB (3 CT+HR+ bile duct resection (BDR), 3 HR, 1 hepatopancreatoduodenectomy +CT), 10 III [4 CT+HR, 5 extensive HR (eHR), 1 HR+right colectomy+BDR+total gastrectomy], 2 IV (2 eHR). Overall 1-, 3-, 5-year survival was 67%, 46%, 34% respectively for stage IA-IB; 63%,12%, 12% for IIA-IIB; 50%, 30%, 30% for III-IV (p=ns); in particular, 1-, 3-, 5-year survival was 100%, 100%, 100% for T1a; 50%, 50%, 50% for T1b; 70%, 46%, 35% for T2; 50%, 12%, 12% for T3; 54%, 32%, 32% for T4 (p=ns); 1-, 3-, 5-year survival for patients without lymph node involvement was 58%, 44%, 37% and 60%, 15%, 15% for patients with lymph node metastases (p=ns), respectively.
  
  
  CONCLUSIONS
  CT seems to be sufficient in T1a GBC patients but inadequate in T1b (stage IA), which requires a more aggressive approach. In stage IIB, III and IV, the presence of lymph-node metastasis is not a contraindication to aggressive surgery.
authors.affiliation: Department of Surgery and Transplantation, University of Bologna, S Orsola-Malpighi Hospital, Italy. aprincipe@aosp.bo.it
authors.forename: Alfonso
authors.initials: A
authors.lastname: Principe
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery; D002763:Cholecystectomy; D013505:Digestive System Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies