title: Bile duct involvement portends poor prognosis in resected gallbladder carcinoma.
abstract: BACKGROUND
  Gallbladder cancer (GBC) carries an unfavorable prognosis with high mortality. This retrospective study was conducted to identify prognostic factors after resection of GBC, to assist in selecting appropriate surgical and adjuvant therapy.
  
  
  METHODS
  Sixty-two patients from two institutions were identified with GBC by pathology. In 25, the cancer was unresectable at presentation. The remaining 37 patients comprised the study population. Log-rank analysis was used to assess univariate association with disease-free survival (DFS) and disease-specific survival (DSS). Cox regression was used for multivariate analysis.
  
  
  RESULTS
  Median DFS and DSS were 22.6 and 28.5 months respectively, with a median follow-up of 44.2 months. On univariate analysis, bile duct (BD) involvement was significantly associated with decreased DFS (P ≤ .001) and DSS (P = .004). BD involvement was uniformly fatal. LN involvement was not significantly associated with DFS or DSS (P = .85, P = .54).
  
  
  CONCLUSIONS
  All patients with BD involvement in our population died of the disease. The subset of patients with resectable GBC and BD involvement is a group that is at high risk for recurrence and should be treated as such. In our small population, preoperative and intraoperative methods evaluating BD involvement were unreliable.
authors.affiliation: Division of Surgical Oncology Oregon Health and Sciences University Portland, OR.
authors.forename: Robert
authors.initials: R
authors.lastname: Eil
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.forename: Maria
authors.initials: M
authors.lastname: Cassera
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: Brian
authors.initials: B
authors.lastname: Diggs
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Billingsley