Surgical management for carcinoma of the gallbladder: a single-institution experience in 25 years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gallbladder carcinoma is rare and associated with dismal outcomes. Radical surgery is the only curative treatment, and options for adjuvant therapy remain limited. This study aimed to determine the factors influencing outcome of treatment in patients with gallbladder carcinoma, and to identify the patients who might benefit from radical surgery and adjuvant therapy.</p><p><b>METHODS</b>Medical records and follow-up histories of 150 patients with gallbladder carcinoma who had undergone surgery between April 1980 and December 2005 were retrospectively reviewed. The factors predictive for the survival of the patients were identified using multivariate analysis.</p><p><b>RESULTS</b>Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 26.2%. After curative resection (40% of the patients), the 5-year survival rate was 60.3%. The patients who underwent R0 resection had a significantly longer median survival (97.3 months) than those who had R1/R2 resection (8.3 months) or only laparotomy (3.7 months) (P < 0.0001). Univariate analysis showed that resectability, American Joint Committee on Cancer staging, tumor grade, adjuvant therapy, jaundice at presentation, depth of tumor invasion, lymph node involvement, distant metastasis, and carcinoembryonic antigen level were statistically significant predictors for survival. Multivariate analysis revealed American Joint Committee on Cancer staging and resectability were independent prognostic factors for survival. The patients who underwent noncurative resection might benefit from adjuvant therapy (median survival, 12.4 months vs 7.2 months, P = 0.006).</p><p><b>CONCLUSIONS</b>Favorable survival rate can be achieved after curative resection, even for selected patients with advanced disease. Adjuvant therapy may improve the survival of patients with gallbladder carcinoma.</p>

Simultaneous liver and colorectal resection for synchronous colorectal liver metastasis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and long term outcome of simultaneous liver and colorectal resection for synchronous colorectal liver metastasis.</p><p><b>METHODS</b>Forty-three synchronous colorectal liver metastasis patients who received simultaneous colectomy and hepatectomy between May 1981 and November 2005 were analyzed retrospectively.</p><p><b>RESULTS</b>The group included 21 male patients and 22 female patients, with the median age of 52 years. The overall median operative time was 180 minutes, 30 cases received blood transfusion, and the median volume was 800 ml. The median hospital stay was 15 days. The morbidity and mortality was 18.6% and 2.3%, respectively. The overall median survival time was 25 months, 5-year survival rate was 19.1%. The survival of patients underwent R0 resection were substantially better (median survival time 48 months, 5-year survival rate 33.8%) than that of the patients who did not undergo R0 resection (20 months, 7.6%) (P = 0.002).</p><p><b>CONCLUSIONS</b>Simultaneous liver and colorectal resection is safe and effective for synchronous colorectal liver metastasis. Furthermore, simultaneous R0 resection should be the optimal surgery for the resectable cases.</p>