title: Outcome of radical surgery for stage IV gallbladder carcinoma.
abstract: OBJECTIVE
  The role of aggressive surgery for patients with stage IV gallbladder carcinoma was examined.
  
  
  METHODS
  Cancers were classified according to the TNM system of the Japanese Society of Biliary Surgery. The survival of 37 patients with stage IV cancer (stage IVa, n = 15; stage IVb, n = 22) treated by surgical resection during the period January 1990 to December 2004 was examined and compared with the survival of 41 patients with stage IV disease not treated by surgical resection during the same period.
  
  
  RESULTS
  The postoperative survival rate was significantly better for patients with resected stage IVa cancer than for patients with resected stage IVb disease and for those with nonresected stage IV disease. Survival in patients with N3 lymph node metastasis, liver metastasis, peritoneal dissemination, or vascular invasion was poor, like that in the nonresected group. Surgical resection without residual tumors (curability A and B) yielded a significantly better outcome than that with residual tumor (curability C). There were three 5-year survivors that were treated successfully by curative resection (curability A and B) and all had T4N0 disease.
  
  
  CONCLUSIONS
  These results suggest that surgical resection significantly improves survival even in patients with stage IV gallbladder carcinoma when N3 metastasis, liver metastasis, peritoneal dissemination, and vascular invasion are absent. Curative resection can be expected to produce long-term survival in selected patients with stage IV gallbladder carcinoma.
authors.affiliation: First Department of Surgery, Miyazaki University School of Medicine, Miyazaki, 889-1692, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kai
authors.forename: Motoaki
authors.initials: M
authors.lastname: Nagano
authors.forename: Masahide
authors.initials: M
authors.lastname: Hiyoshi
authors.forename: Jiro
authors.initials: J
authors.lastname: Ohuchida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome