title: Surgical management for carcinoma of the gallbladder: a single-institution experience in 25 years.
abstract: BACKGROUND
  Gallbladder carcinoma is rare and associated with dismal outcomes. Radical surgery is the only curative treatment, and options for adjuvant therapy remain limited. This study aimed to determine the factors influencing outcome of treatment in patients with gallbladder carcinoma, and to identify the patients who might benefit from radical surgery and adjuvant therapy.
  
  
  METHODS
  Medical records and follow-up histories of 150 patients with gallbladder carcinoma who had undergone surgery between April 1980 and December 2005 were retrospectively reviewed. The factors predictive for the survival of the patients were identified using multivariate analysis.
  
  
  RESULTS
  Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 26.2%. After curative resection (40% of the patients), the 5-year survival rate was 60.3%. The patients who underwent R0 resection had a significantly longer median survival (97.3 months) than those who had R1/R2 resection (8.3 months) or only laparotomy (3.7 months) (P < 0.0001). Univariate analysis showed that resectability, American Joint Committee on Cancer staging, tumor grade, adjuvant therapy, jaundice at presentation, depth of tumor invasion, lymph node involvement, distant metastasis, and carcinoembryonic antigen level were statistically significant predictors for survival. Multivariate analysis revealed American Joint Committee on Cancer staging and resectability were independent prognostic factors for survival. The patients who underwent noncurative resection might benefit from adjuvant therapy (median survival, 12.4 months vs 7.2 months, P = 0.006).
  
  
  CONCLUSIONS
  Favorable survival rate can be achieved after curative resection, even for selected patients with advanced disease. Adjuvant therapy may improve the survival of patients with gallbladder carcinoma.
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Jian-wei
authors.initials: JW
authors.lastname: Liang
authors.forename: Shu-xiao
authors.initials: SX
authors.lastname: Dong
authors.forename: Zhi-xiang
authors.initials: ZX
authors.lastname: Zhou
authors.forename: Yan-tao
authors.initials: YT
authors.lastname: Tian
authors.forename: Dong-bing
authors.initials: DB
authors.lastname: Zhao
authors.forename: Cheng-feng
authors.initials: CF
authors.lastname: Wang
authors.forename: Ping
authors.initials: P
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate