Is there a role for cholecystectomy in gallbladder carcinoma discovered to be unresectable for cure at laparotomy?
BACKGROUND
Palliative operative resection in patients with locally advanced cancer of the gallbladder (GBC) found not to be amenable to radical resection for cure at exploration has received little attention. This article evaluates the benefits, if any, of cholecystectomy with biliary drainage in such patients.


METHODS
Available records of locally advanced but nonmetastatic GBC patients treated in the Department of Surgical Oncology, B.H.U., Varanasi, India, during the last 8 years were retrospectively reviewed. Of these, 30 patients (group I) with GBC (T(3-4),N(0-1),M(0)) treated with cholecystectomy +/- biliary bypass were selected and compared with equal number of controls matched for age (+/-5 years), sex, histopathology, stage, residence, and postoperative chemotherapy who underwent biopsy +/- biliary bypass only (group II) followed by chemotherapy during the same period. Survival rates were calculated by using Kaplan-Meier curves. Follow-up ranged from 1-15 months.


RESULTS
The median survival was 7 and 2 months for groups I and II (P < 0.0001), respectively. The 30-day postoperative mortality and morbidity was 3% vs. 12% and 13% vs. 16% in groups I and II, respectively.


CONCLUSIONS
Results suggest that a better median survival can be achieved after cholecystectomy in locally advanced unresectable GBC compared with only bypass and biopsy procedures. These findings may justify a palliative cholecystectomy in selected patients with locally advanced GBC.
Tewari
Mallika
M
Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
Kumar
Vinay
V
Mishra
Raghvendra R
RR
Kumar
Mohan
M
Shukla
Hari S
HS
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D015331:Cohort Studies; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome