title: The standardized surgical approach improves outcome of gallbladder cancer.
abstract: BACKGROUND
  The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer.
  
  
  METHODS
  The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation.
  
  
  RESULTS
  Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014). The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct.
  
  
  CONCLUSIONS
  Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.
authors.affiliation: Department of General-, Visceral-, Vascular- and Paediatric Surgery, University Hospital, University of the Saarland, D-66421 Homburg, Germany. chstsc@uniklinik-saarland.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Scheingraber
authors.forename: Christoph
authors.initials: C
authors.lastname: Justinger
authors.forename: Tatiana
authors.initials: T
authors.lastname: Stremovskaia
authors.forename: Malte
authors.initials: M
authors.lastname: Weinrich
authors.forename: Dorian
authors.initials: D
authors.lastname: Igna
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D016022:Case-Control Studies; D002763:Cholecystectomy / Q000379:methods* / Q000592:standards; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods* / Q000592:standards; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome