title: Surgical resection for advanced gallbladder carcinoma. The Mount Sinai experience.
abstract: OBJECTIVE
  Advanced gallbladder cancer (GC) carries dismal prognosis, due to its extent at diagnosis and the low R0 resection performance rate.
  
  
  METHODS
  Thirty-two GC patients referred to our Department with an intention to treat between 1993 and 2005. All patients had advanced T stage (> or = T3). Pathological findings, surgical procedures and survival data were analyzed.
  
  
  RESULTS
  Seventeen radical procedures (16 hepatectomies and 1 cholecystectomy with common bile duct resection), 4 palliative procedures (12.5%) and 11 surgical explorations (34.4%) were performed (53.1%, resectability rate). Hepatectomies were performed with 0% mortality, 11.8% morbidity and 94.1% resectability rate. The respective 1-, 3- and 5- year survival rates were 71.4%, 28.6% and 14.3%. Radical lymph node dissection (p = 0.03), absence of perineural tumor invasion (p = 0.03) and patients' age <70 years (p < 0.01) were non-independently associated with favorable prognosis in the hepatectomy-treated group of GC patients.
  
  
  CONCLUSIONS
  GC patients with stage > or = IIA should be treated with hepatectomy combined with radical lymphadenectomy in order to achieve better staging and disease control. Incorporating the caudate lobe, more than 4 liver segments, or part of the extrahepatic biliary tree in the resection specimen in selected patients, might help eliminate perineural metastatic spread and achieve improved overall survival.
authors.affiliation: Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY, USA. manousos.konstadoulakis@mountsinai.org
authors.forename: Manousos M
authors.initials: MM
authors.lastname: Konstadoulakis
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Ilias P
authors.initials: IP
authors.lastname: Gomatos
authors.forename: Daniel
authors.initials: D
authors.lastname: Labow
authors.forename: Maria-Isabell
authors.initials: MI
authors.lastname: Fiel
authors.forename: Charles M
authors.initials: CM
authors.lastname: Miller
authors.forename: Myron E
authors.initials: ME
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies