title: Long-term survival of a recurrent gallbladder carcinoma patient with lymph node and peritoneal metastases after multidisciplinary treatments: a case report.
abstract: BACKGROUND
  Gallbladder carcinoma with peritoneal metastasis has a poor prognosis, with a median survival time of 4.8 months. We report the survival of a patient with gallbladder carcinoma with peritoneal metastasis for 7.6 months owing to treatment with tumor resection after chemoradiotherapy.
  
  
  METHODS
  A 69-year-old man was referred to our hospital for gallbladder carcinoma with hepatic invasion. Cholecystectomy was performed along with S4a and S5 hepatectomy and extrahepatic bile duct resection with lymph node dissection. The postoperative pathological diagnosis was moderately differentiated adenocarcinoma, T3, N0, M0, stage IIIA by the International Union Against Cancer TNM classification. Despite treatment with gemcitabine, the common hepatic artery and para-aortic lymph nodes showed metastases after 3 months from surgery. Although a combination of cisplatin, gemcitabine, and radiotherapy reduced the size of the lymph node metastasis, the peritoneal metastasis persisted. The peritoneal metastasis responded to chemoradiotherapy using tegafur-uracil and leucovorin, but it recurred. The metastasis was resected after 3 years and 9 months from the first surgery, and chemotherapy was discontinued. Seven years and 6 months after the initial surgery, the patient exhibited no signs of tumor recurrence or metastasis.
  
  
  CONCLUSIONS
  Multidisciplinary treatment including resection without residual tumors could achieve complete remission of gallbladder carcinoma with lymph node and peritoneal metastases in the selected patient.
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. ktomita-jik@umin.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. kiminoriman526@yahoo.co.jp.
authors.forename: Kiminori
authors.initials: K
authors.lastname: Takano
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. shimazu@tokyo-med.ac.jp.
authors.forename: Motohide
authors.initials: M
authors.lastname: Shimazu
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. hopstepjump1192@gmail.com.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Okihara
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. tha7stars_in_tmu@yahoo.co.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Sano
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. nchiba0632@yahoo.co.jp.
authors.forename: Naokazu
authors.initials: N
authors.lastname: Chiba
authors.affiliation: Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan. skawachi@tokyo-med.ac.jp.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
keywords: Chemoradiotherapy; Gallbladder carcinoma; Long-term survival; Multidisciplinary treatment; Peritoneal metastasis; Resection