IS RADICAL SURGERY IN LOCALLY ADVANCED GALLBLADDER CARCINOMA JUSTIFIED

Objectives: Advanced gallbladder carcinoma is associated with a dismal long term prognosis. The aim of the present study was to evaluate the effectiveness of radical surgery in advanced stages of gallbladder ca rcinoma. Methods: The course of 66 patients operated for advanced gall bladder carcinoma was evaluated in a retrospective study; 14% of patie nts had stage II, 29% had stage III, and 57% had stage IV tumors. Twel ve patients underwent cholecystectomy (CHE) and lymphadenectomy of the hepatoduodenal ligament (LA); 17 patients underwent cholecystectomy c ombined with segment IV/V liver resection (CHE + LR) and LA; and 10 pa tients underwent right extended hemihepatectomy (EHH). Complete tumor resection (R0) was achieved in six patients with CHE and LA, in 14 pat ients with CHE combined with segment IV/V LR and LA, and in all patien ts with right EHH. Resections with microscopic residual tumor (R1) wer e performed in nine patients. Mean follow-up was 15.4 months (range 3- 90 months). Results: The periopertive mortality rate was 1.5%, and the morbidity rate was 20%. In R0 resections, mean survival was 23.3, 25. 0, and 26.3 months for the patients who underwent CHE and LA, CHE comb ined with segment IV/V LR and LA, and right EHH, respectively. After 2 4 months, 46.4% of the patients with R0 resection were still alive com pared with none of the patients with residual tumor. In the patients w ith R0 resection, no difference in survival was detected when node-neg ative status (pN0) was compared with positive locoregional lymph nodes (pN1a), whereas the degree of dedifferentiation (G2/G3) influenced su rvival. Conclusions: If complete resection is achieved, radical surgic al procedures, including segment IV/V liver resection and extended rig ht hepatectomy, significantly improve survival rates with an acceptabl e morbidity and mortality rate.