Clinicopathologic differences between long-term and short-term postoperative survivors with advanced gallbladder...

The objective of this study was to determine histopathologic factors that influence the failure or success of extended cholecystectomy and more aggressive surgery to attain long-term survival in patients with advanced carcinoma of the gallbladder. Of 46 patients with carcinoma of the gallbladder who had undergone surgical resection, 36 had advanced carcinoma invading to or beyond the subserosal layer. Among these 36 patients were 10 long-term survivors (> 5 years) and 11 short-term survivors who died of recurrence (< 37 months) after extended cholecystectomy or more extensive surgery. Factors were compared between the two groups. Significant factors observed in the long-term survivors were the depth of invasion limited to the subserosal layer (p < 0.05), hepatic infiltration < 5 mm (p < 0.01), histologic grade of papillary or well differentiated adenocarcinoma (p < 0.01), absent or minimal venous, lymphatic, and perineural invasion (p < 0.01), and lymph node metastasis limited to the hepatoduodenal ligament (p < 0.05). It was concluded that the patients with subserosal invasion have a hope for long-term survival by extended cholecystectomy or more aggressive surgery when hepatic infiltration and venous, lymphatic, and perineural invasion are absent or minimal, the histologic grade is papillary or well differentiated adenocarcinoma, and lymph node metastasis is limited to the hepatoduodenal ligament.