title: Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience.
abstract: OBJECTIVE
  To determine the prevalence of incidentally found cases of gallbladder cancer, the incidence of residual disease at reexploration, and the changes in the mode of presentation, treatment, and survival of patients with gallbladder cancer during a period of more than 4 decades.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  University-affiliated tertiary care center.
  
  
  METHODS
  Between January 1, 1962, and March 1, 2008, 402 patients with gallbladder cancer were identified and their clinicopathologic data were analyzed.
  
  
  METHODS
  Surgical treatment, radiotherapy, and chemotherapy.
  
  
  METHODS
  Incidentally discovered gallbladder cancer, incidence of residual disease, and differences in presentation, treatment, and survival.
  
  
  RESULTS
  Surgical exploration was performed in 260 patients (64.7%), of whom 151 (58.1%) underwent resection. The median age of the patients was 72 years, and 72.3% were female. Between January 1, 1994, and March 1, 2008, 6881 laparoscopic cholecystectomies were performed, and there were 17 incidentally discovered cases of gallbladder cancer (0.25%). Residual disease on reexploration was identified in 0 of 2 patients with T1 tumor, 3 of 13 patients with T2 tumor, and 8 of 10 patients with T3 tumor (P = .01). Patients with stage IV disease (34 [13.1%] diagnosed from 1962-1979; 34 [13.1%] diagnosed from 1980-1997; and 22 [8.5%] diagnosed from 1998-2008) had a median survival of 4 months (range, 0-37 months). Concomitant liver resections increased in the third study period (11.1%, 10.1%, and 54.3%; P < .001), with an increase in negative margins (33.3%, 42.0%, and 63.0%; P = .01). Cox regression analysis identified T stage and surgical margin status as significant prognostic factors.
  
  
  CONCLUSIONS
  Gallbladder cancer is incidentally found during 0.25% of laparoscopic cholecystectomies. As T stage increases, the likelihood of residual disease on reexploration increases. Although many patients with gallbladder cancer present with incurable disease and have very poor survival, the overall prognosis is improving, likely because of more extensive operations.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Ioannis T
authors.initials: IT
authors.lastname: Konstantinidis
authors.forename: Vikram
authors.initials: V
authors.lastname: Deshpande
authors.forename: Muriel
authors.initials: M
authors.lastname: Genevay
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-del Castillo
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Tanabe
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000453:epidemiology / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate