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Extended operation with or without intraoperative (IORT) and external (EBRT) radiotherapy for gallbladder carcinoma
Gert Lindell1, Torsten Holmin, Sven Börje Ewers
1Department of Surgery, University Hospital, SE-221 85 Lund, Sweden.
Background/Aims:
Gallbladder carcinoma is a rare disease with dismal prognosis. However, lately improved survival has been reported after extended operation including liver resection and lymphadenectomy in addition to cholecystectomy. The aim of this study was to evaluate such a surgical strategy with and without adjuvant intra- and postoperative radiotherapy (IORT/EBRT).
Methodology:
20 patients underwent extended operation and the last 10 of them IORT/EBRT in addition. Tumor staging was done using the TNM system, determination of histological tumor differentiation and immunohistochemical assessment of p53, Ki67, metallothionein, deleted in colorectal cancer and carcinoembryogenic antigen in tumor tissue.
Results:
There was no hospital mortality. Postoperative complications occurred in 3 patients (15%). Actuarial 5-year survival was 47% in the radiotherapy group and 13% after operation only (NS). The corresponding figures for median survival are 28.8 and 20.2 months, respectively. Five patients are still alive in the radiotherapy group. There was no difference in tumour stages of the two groups irrespective of the way of evaluation.
Conclusions:
The results suggest that extended operation for gallbladder carcinoma +/- IORT/EBRT can be done safely. The tendency to longer survival after adjuvant radiotherapy was not statistically significant.