title: Predictors of curative resection and long term survival of gallbladder cancer - A retrospective analysis.
abstract: BACKGROUND
  Gallbladder cancer (GBC) is an aggressive malignancy. We analysed factors predicting resectability and survival of patients with GBC and the impact of surgical obstructive jaundice (SOJ).
  
  
  METHODS
  Four hundred and thirty-seven patients with suspected GBC were analysed (52 excluded: benign pathology n = 35, missed GBC n = 17). The remaining 385 patients were divided into non-SOJ (n = 234) and SOJ (n = 151) groups. Predictors of resectability and long term survival were analysed and compared with their subgroups.
  
  
  RESULTS
  Patients with gastric outlet obstruction, abdominal lump, weight loss and SOJ were more likely to be unresectable (p:0.04, 0.024, 0.003 and 0.003, respectively). TNM stage, node positivity and adjacent organ involvement were predictors of survival (p < 0.001, 0.008 and <0.001). Metastatic (36.7% vs 47.7%), inoperable (1.7% vs 12.6%) and unresectable disease (9.8% vs 24.5%) were more in the SOJ group and had lower curative resection rates (51.7% vs 15.2%; p < 0.0001). The 1,2 and 5-year survival rates were higher in patients in the non-SOJ than SOJ group (79.6%, 65% and 52.9% vs 48.6, 32.4% and 0%; p < 0.001).
  
  
  CONCLUSIONS
  GBC with SOJ is more likely to be unresectable. SOJ, nodal involvement, adjacent organ infiltration and higher TNM stage predict poor survival.
authors.affiliation: Department of Gastrointestinal Surgery, Academic Block GB Pant Hospital, New Delhi, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: Department of Gastrointestinal Surgery, Academic Block GB Pant Hospital, New Delhi, India. Electronic address: sundeepsaluja@yahoo.co.in.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.affiliation: Department of Gastrointestinal Surgery, Academic Block GB Pant Hospital, New Delhi, India.
authors.forename: Nabi
authors.initials: N
authors.lastname: Prithiviraj
authors.affiliation: Department of Gastrointestinal Surgery, Academic Block GB Pant Hospital, New Delhi, India.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Varshney
authors.affiliation: Department of Gastrointestinal Surgery, Academic Block GB Pant Hospital, New Delhi, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Goel
authors.affiliation: Department of Gastrointestinal Surgery, Academic Block GB Pant Hospital, New Delhi, India.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Patil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: Carcinoma gallbladder; Predictors of resectability; Radical cholecystectomy; Resectability in gallbladder cancer; Surgical obstructive jaundice