title: Role of radical surgery in patients with stage IV gallbladder cancer.
abstract: OBJECTIVE
  The role of surgery in stage IV gallbladder (GB) cancer is not well established. This study analyses prognostic factors in patients with stage IV GB cancer following surgical resection with the aim of identifying a subgroup of patients who might benefit from surgical resection.
  
  
  METHODS
  Clinicopathological details were analysed for 94 patients who were surgically treated for stage IV GB cancer at Seoul National University Hospital.
  
  
  RESULTS
  Median survival was 8 months in patients with either stage IVa or IVb disease. Sixteen patients (17.0%) underwent resection with curative intent, which increased overall survival over that in patients undergoing palliative surgery (P < 0.001). No survival benefit was seen following surgery with curative intent in patients with stage IVa disease (P = 0.764). Surgery with curative intent resulted in a survival benefit in patients with stage IVb disease, patients with an isolated liver metastasis near the GB bed (median survival: 31 months vs. 9 months; P < 0.001) and patients with limited numbers of peritoneal implantations (median survival: 20 months vs. 6 months; P = 0.002). Preoperative serum carcinoembryonic antigen (CEA) (P = 0.018), surgery with curative intent (P = 0.045) and adjuvant chemotherapy (P = 0.002) were independent prognostic factors in patients with stage IV GB cancer.
  
  
  CONCLUSIONS
  Surgery in combination with systemic chemotherapy may be beneficial in carefully selected patients with stage IVb GB cancer.
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Youngpeck
authors.initials: Y
authors.lastname: Song
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: In Woong
authors.initials: IW
authors.lastname: Han
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005706:Gallbladder Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000556:secondary; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen