title: Prognostic factors for gallbladder cancer in the laparoscopy era.
abstract: OBJECTIVE
  Hepatobiliary surgery has changed dramatically in recent decades with the advent of laparoscopic techniques. The aim of this retrospective study was to compare survival rates according to stages, adjusting for important prognostic factors.
  
  
  METHODS
  A retrospective study of a 17-year period from January 1994 to April 2011 was carried out. The cases studied were divided into two time period cohorts, those treated in the first 9-years (n = 109) and those treated in the last 7-years (n = 109).
  
  
  RESULTS
  An operation with curative intent was performed on 218 patients. The 5-year survival rates according to the depth of invasion were 86% (T1), 56% (T2), 45% (T3), and 5% (T4). The number of cases of incidental gallbladder cancer found during 3,919 laparoscopic cholecystectomies was 96 (2.4%). Incidental gallbladder cancer revealed a better survival rate (P = 0.003). Iatrogenic bile spillage was found in 20 perforations of the gallbladder during laparoscopic cholecystectomies, 16 preoperative percutaneous transhepatic gallbladder drainages and 16 percutaneous transhepatic biliary drainages; only percutaneous transhepatic biliary drainage patients showed a significantly lower survival rate than patients without iatrogenic bile spillage (P < 0.034). Chemoradiation appeared to improve overall survival (P < 0.001). Multivariate analysis also revealed that time period, type of surgery, surgical margin, lymphovascular invasion, lymph node involvement, and chemoradiation therapy had significant effects.
  
  
  CONCLUSIONS
  This study found that the prognosis of gallbladder cancer is still determined by the stage at presentation due to the aggressive biology of this tumor. Early diagnosis, radical resection and appropriate adjuvant therapy can increase overall survival.
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Hak Youn
authors.initials: HY
authors.lastname: Lee
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Ghap Joong
authors.initials: GJ
authors.lastname: Jung
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Roh
authors.forename: Si Young
authors.initials: SY
authors.lastname: Park
authors.forename: Nam Uk
authors.initials: NU
authors.lastname: Kang
authors.forename: Soon Hwa
authors.initials: SH
authors.lastname: Yoon
authors.forename: Jin Han
authors.initials: JH
authors.lastname: Cho
authors.forename: Myung Hwan
authors.initials: MH
authors.lastname: Roh
authors.forename: Sang Young
authors.initials: SY
authors.lastname: Han
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Baek
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Jeong
keywords: Gallbladder cancer; Laparoscopy; Prognosis