Radical Surgery for Carcinoma of the Gallbladder

ABSTRACT

BACKGROUND: Carcinomas of the gallbladder have a poor prognosis, and the only chance for cure lies in early detection and complete surgical resection. The objective of this study was to determine the outcomes of surgical treatment for gallbladder carcinomas, with special reference to the histopathologic characteristics. METHODS: Seventy patients with gallbladder carcinomas were operated on during a period of seven years. Of those 42 patients underwent a resection for cure and were included in this study. The clinicopathologic data were collected, and the survival was measured. RESULTS: The resection rate was 60.0%. Operative morbidity and mortality were 14.3% and 4.8%, respectively. The 3-year survival rate after resection was 61.1%. The survival rate was significantly higher in patients with negative lymph-node metastasis and in those with a curative resection. Regional lymph-node metastasis, venous invasion, lymphatic permeation, and perineural infiltration increased with the depth of tumor invasion. In cases limited to the mucosa, no lymph-node metastasis or other extensions were observed. In patients with stage I gallbladder carcinomas, the outcome was good after a simple cholecystectomy alone. In stage II to IV, the survival rate for patients with a radical resection was higher than that for those with a simple cholecystectomy. CONCLUSIONS: Improved survival in gallbladder carcinomas can be achieved by a radical resection, including various types of liver resections and regional lymphadenectomies. Patients with tumors limited to the mucosa can be treated for cure by a simple cholecystectomy. In more advanced stages, a radical resection should be performed.