RADICAL SURGERY FOR ADVANCED GALLBLADDER CARCINOMA

Forty-four patients with advanced gallbladder carcinoma (18 with stage pT(3) and 26 with stage pT(4) of the Union Internacional Contra la Ca ncrum classification) were aggressively managed by extended heptatic r esection in duct resection in 28, pancreaticoduodenectomy in seven, ga strointestinal resection in eleven and portal vein resection and recon struction in seven. Adjacent organ involvement was classified as follo ws: type I, hepatic involvement with or without gastrointestinal invas ion (Ia, Ib); type II, bile duct involvement with or without gastroint estinal invasion (IIa, IIb); type III, hepatic and bile duct involveme nt with or without gastrointestinal invasion (IIIa, IIIb); type IV, ga strointestinal involvement without hepatic or bile duct invasion. Four teen of 15 patients with type I tumours had a curative resection compa red with seven of 26 with type III lesions (P < 0.0001). The surgical mortality rate was two of 15 patients with type I tumours, seven of 26 with type III tumours and nine of 44 for the whole group. The long-te rm survival rate after curative resection was four and two of 23 at 3 and 5 years respectively, significantly better than two and none of 21 at 1 and 2 years after noncurative resection (P < 0.01). The survival rate after curative resection for patients with type I tumours was fo ur and two of 14 at 3 and 5 years respectively, significantly better t han for other types (P < 0.05). This classification of advanced gallbl adder carcinoma according to involvement of adjacent organs might be h elpful in planning surgery for this condition; in particular, type I t umours should be treated by a radical surgical procedure to achieve a favourable outcome.