title: Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic centre with review of the literature.
abstract: BACKGROUND
  There is no consensus regarding the optimum surgical approach to gallbladder cancer. This study reviews the management of gallbladder cancer in a single unit.
  
  
  METHODS
  Retrospective study of 73 consecutive patients diagnosed with gallbladder cancer. Twenty-three patients underwent surgery with curative intent (surgical group), 28 patients underwent exploratory surgery but had inoperable disease (surgically inoperable group) and 22 patients had inoperable disease radiologically (radiologically inoperable group). Within the surgical group, nine patients (cholecystectomy group) were diagnosed with gallbladder cancer after routine cholecystectomy.
  
  
  RESULTS
  The inoperable groups had significantly higher bilirubin and alkaline phosphatase (ALP) than the surgical group (p=0.02 and p<0.01, respectively). Age>68, white cell count (WCC)>7.6 x 109/L, platelet>345 x 109/L, bilirubin>16 mol/L, ALP >124 iu/L and sodium < or = 137 mmol/L were markers of inoperability. Age, haemoglobin and neutrophil:lymphocyte ratio (NLR) were predictors for survival following surgery (p=0.04, p=0.01 and p<0.01, respectively). The surgical and cholecystectomy groups had significantly higher median survivals than the surgically and radiologically inoperable groups (18.97 and 26.17 months versus 5.03 and 12.20 months, p=0.04).
  
  
  CONCLUSIONS
  Curative surgical resection of gallbladder cancer improved survival. Exploratory laparotomy which revealed inoperable disease reduced survival. Preoperative WCC, platelet, bilirubin and ALP may be used as additional discriminators during the investigation and work up prior to surgery.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK. seokling.ong@googlemail.com
authors.forename: Seok L
authors.initials: SL
authors.lastname: Ong
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Thomasset
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Neal
authors.forename: David M
authors.initials: DM
authors.lastname: Lloyd
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison