TREATMENT OF T3 AND T4 CARCINOMAS OF THE GALLBLADDER

Forty-nine patients with T3 and T4 carcinoma of the gallbladder were t reated by three different regimens. Group I consisted of 26 patients t reated With combined resection alone; group 2 was twelve patients whos e tumors had spread to the hepatoduodenal ligament treated with combin ed resection plus intraoperative radiation therapy; group 3 comprised eleven patients with nonresectable tumors treated with hyperthermia in combination with chemoradiation therapy (HCRT). The difference in the survival rates between group 1 and 2 were statistically significant ( p<0.001); however, the difference between group 2 and 3 was not signif icant. In group 1, there was a significant difference between patients with and without lymph node involvement in the 3-year survival rate ( p<0.01). Thus, the only patients without involvement of regional lymph nodes and the hepatoduodenal ligament have the best potential for lon g-term survival through aggressive surgical approaches, HCRT mal provi de an alternative palliation for patients with advanced carcinoma show ing obstructive jaundice.