title: Surgical approaches to advanced gallbladder cancer : a 40-year single-institution study of prognostic factors and resectability.
abstract: OBJECTIVE
  The aim was to evaluate prognostic factors and factors associated with the resectability of advanced gallbladder cancer (GBC).
  
  
  METHODS
  This was a single-institution retrospective review of 274 consecutive surgically-treated cases of advanced GBC (excluding incidental GBC and early GBC). Univariate and multivariate analysis were performed to assess prognostic variables. R0 resection and survival rates were investigated for each local extension factor.
  
  
  RESULTS
  Long-term survival was uncommon among patients with multiple liver metastases (H2-3: n = 22; 2-year survival, 0 %), dissemination (P1-3: n = 16; 3-year survival, 0 %), invasion through the hepatoduodenal ligament (Binf3: n = 45; 5-year survival, 4.6 %), or group 3 lymph node (LN) metastasis including of the para-aortic LN (N3: n = 52; 13.7 %). Long-term survival rates did not differ significantly between patients who did and did not undergo bile duct resection or pancreaticoduodenectomy. Survival did not differ significantly according to the type of hepatectomy performed.
  
  
  CONCLUSIONS
  Surgery may not be indicated for patients with multiple liver metastasis, dissemination, Binf3, or visible para-aortic LN metastasis. Furthermore, it is important to achieve R0 surgery in cases of GBC.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Higuchi
authors.forename: Takehiro
authors.initials: T
authors.lastname: Ota
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Araida
authors.forename: Hideki
authors.initials: H
authors.lastname: Kajiyama
authors.forename: Takehisa
authors.initials: T
authors.lastname: Yazawa
authors.forename: Toru
authors.initials: T
authors.lastname: Furukawa
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors