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Primary carcinoma of the gallbladder: results of surgery--a retrospective study
1Department of Surgery, General Surgery, Mackay Memorial Hospital-Taipei, Taiwan, ROC.
Background:
The development of hepatobiliary imaging modalities has resulted in earlier detection of gallbladder cancer. This is a retrospective evaluation of surgical resection of gallbladder cancer.
Methods:
Records of 58 patients with gallbladder carcinoma who underwent surgical resection in the past 14 years were examined. Patients were staged according to the Nevin system: six had Nevin stage I disease; 10, stage II; 9, stage III; four, stage IV; and 24 had stage V cancer. Forty-three patients were thought to have resectable lesions. Of these, 14 had extended cholecystectomy, 21 simple cholecystectomy, seven simple cholecystectomy with biliary drainage and one patient had radical cholecystectomy with pancreaticoduodenectomy. Prognoses were analyzed in relation to pathologic staging and surgical procedures.
Results:
The overall one-year and five-year survival rates were 50% and 19.2%, respectively. The five-year survival rate for Nevin stage I was 100%; for stage II, 60%; stage III, 33%; stage IV, 25% and for stage V, 0%. Radical surgery led to a better cumulative survival rate for Nevin stages III and IV (p < 0.01) than did simple cholecystectomy. Five Stage II cases were treated with simple cholecystectomy but two patients had early metastasis. Four stage III patients underwent simple cholecystectomy and three had metastasis within one year.
Conclusions:
Based on these results, stage III and IV tumors require extended procedures for better survival. A high index of suspicion for the disease, careful intraoperative examination of the gallbladder specimen and earlier, more aggressive treatment may improve patient survival.