title: Aggressive Surgery for Locally Advanced Gallbladder Cancer with Obstructive Jaundice: Result of a Prospective Study.
abstract: OBJECTIVE
  The aim of this study was to clarify the clinical impact of our departmental policy for advanced gallbladder cancer (GBC) even with obstructive jaundice.
  
  
  METHODS
  Obstructive jaundice was defined as serum T-bil ≥2.0 mg/dl. Between 1998 and 2008, 112 patients with GBC were scheduled for surgical resection with curative intent. Thirty-six patients were converted to palliative surgery or exploration alone because of advanced disease. After excluding pathological T1 (UICC) patients (n = 11), the remaining 65 patients were divided into 2 groups; jaundiced group (n = 37) and non-jaundiced group (n = 28). Surgical procedures were conducted based on our departmental guidelines concerning each type of infiltration of GBC.
  
  
  RESULTS
  Bile duct resection and major hepatectomy were performed more frequently in patients with jaundice. Although patients in jaundiced group had more advanced disease, 5-year overall survival rates of the patients with or without jaundice were 27 vs. 31% (p = 0.742), which was not statistically significant.
  
  
  CONCLUSIONS
  Aggressive surgery might improve long-term survival in patients with locally advanced GBC even in the condition of obstructive jaundice with no distant metastasis.
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Nasu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016134:Organizational Policy; D016577:Pancreaticoduodenectomy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015996:Survival Rate