Radical surgery for gallbladder carcinoma: possibilities of survival

Background: The surgical treatment of gallbladder cancer has improved significantly in recent years. The aim of this study was to evaluate retrospectively the surgical outcome for patients with gallbladder carcinoma and to identify patients who may benefit from radical surgery according to the TNM stage AJCC-2002. Methodology: one-hundred-eighteen patients with gallbladder carcinoma were observed between 1982-2003. Seventy-four (63%) was female and 44 (37%) males; overall age was 63 years (range 38-91). Incidental tumor was found during cholecystectomy (CT) in 25 (21%) patients. Results: Among the 118 patients, 35 (36%) were treated radically: 3 stage IA (3 CT), 10 stage IB (3CT, 3 Wedge-Resection (WR), 4 (HR), 3 stage IIA (3 HR), 7 stage IIB (3 HR+extrahepatic bile duct resection (BDR), 3 HR, 1 hepato-pancreatoduodenectomy(HPD), 10 stage III (5 HR, 2 extensive HR (eHR), 2 mesohepatectomies enlarged to the segment IVa, 1 HPD + right colectomy+BDR+total gastrectomy, 2 stage IV (1 right HR and 1 mesohepatectomy enlarged to the segment IVa). The 1-, 3-, 5-year survival was 67%, 46%, 34% for stage IA-IB; 63%,12%, 12% for IIA-IIB; 50%, 30%, 30% for III-IV (p=ns). Regarding the T and N classification, the 1-, 3-, 5- year survival was 100%, 100%, 100% for T1a; 50%, 50%, 50% for T1b; 70%, 46%, 35% for T2; 50%, 12%, 12% for T3; 54%, 32%, 32% for T4 (p=ns); whereas the 1-, 3-, 5- year survival for patients without lymph node involvement was 58%, 44%, 37% and 60%, 15%, 15% for patients with lymph node metastases (p=ns). Conclusion: contrariamente a quanto si affermava in passato CT seems to be sufficient only in pT1a patients but inadequate in pT1b (stage IA), in which is indicate a more aggressive surgical treatment as for the stage IIA. In stage IIB, III and IV, the presence of lymph-node metastasis is not a contraindication to aggressive surgery.