title: Aggressive Surgical Approach for Gallbladder Cancer: a Single-Center Experience from Northern India.
abstract: BACKGROUND
  Gallbladder cancer (GBC) is an aggressive disease with dismal results of surgical treatment mainly because of advanced stage at presentation. The objective of this study was to investigate whether aggressive surgical treatment can be associated with reasonable survival for patients with GBC at acceptable morbidity and mortality.
  
  
  METHODS
  A total of 113 patients with proven or presumptive diagnosis of GBC were recruited prospectively over a period of 2 years and evaluated for diagnosis and staging by appropriate investigations. Seven out of 113 patients were found to have benign pathology either intraoperatively or on histopathological examination hence excluded from follow-up and survival analysis. Out of 32 potentially resectable patients, only 21 patients could finally be resected with curative intent. Patients found unresectable/metastatic disease intraoperatively (n = 11) were treated with palliative chemotherapy if eligible for the same. Short-term morbidity, perioperative mortality, disease-free survival (DFS), and median overall survival (OS) of surgically resected patients were analyzed. Median OS of resected patients was compared with that of unresectable patients.
  
  
  RESULTS
  Overall resectability rate in this study cohort was 19.8 % (21/106). Overall mortality was 4.7 % and morbidity was 42.8 %. Stage distribution of resected patients was as follows: stage II (3), stage IIIA (9), stage IIIB (8), and stage IVA (1). DFS at 12 and 18 months was found to be 82.5 and 73.3 %, respectively. Mean DFS was 19.9 months (SE 1.42, 95 % CI). Mean OS for resected patients was 21 months and that for unresectable patients was 11.3 months only. Both groups were compared using log rank (Mantel-cox) test and statistically significant difference in OS was observed (p value <0.0001).
  
  
  CONCLUSIONS
  Since curative resection is the only chance of cure, aggressive surgical approach adopted by us is justified with acceptable mortality and morbidity and encouraging overall survival.
authors.affiliation: Army Hospital (Research & Referral), New Delhi, 10, India. mlnsantosh@yahoo.co.in.
authors.forename: Santosh Kumar
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Army Hospital (Research & Referral), New Delhi, 10, India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Talwar
authors.affiliation: Army Hospital (Research & Referral), New Delhi, 10, India.
authors.forename: Narayanan
authors.initials: N
authors.lastname: Kannan
authors.affiliation: Army Hospital (Research & Referral), New Delhi, 10, India.
authors.forename: Arvind Kumar
authors.initials: AK
authors.lastname: Tyagi
authors.affiliation: Army Hospital (Research & Referral), New Delhi, 10, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Jaiswal
authors.affiliation: Army Hospital (Research & Referral), New Delhi, 10, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Kumar
mesh_terms: D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007194:India; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
keywords: Gallbladder cancer; Hepatic resection; Pancreaticoduodenectomy; Radical cholecystectomy