OUTCOME OF RADICAL SURGERY FOR CARCINOMA OF THE GALLBLADDER ACCORDINGTO THE TNM STAGE

Background. The role of surgery in the treatment of gallbladder carcin oma (GBC) is controversial. The outcome after prospective radical surg ery for GBC is discussed on the basis of the TNM stage of the tumor. M ethods. One hundred six patients who had undergone radical surgery wer e selected. The standard radical procedure consisted of a cholecystect omy accompanied by lymph node dissection, wedge resection of the liver , and resection of the extrahepatic bile ducts. The stage was determin ed by pathologic examination of resected specimens. Results. Lymph nod e metastases were identified in no patients with T1 tumors (n = 15), 4 8% of patients with T2 tumors (n = 46), 72% of patients with T3 tumors (n = 25), and 80% of patients with T4 tumors (n = 20). One patient di ed within 30 days after radical surgery (mortality rate, 0.9%). There were 35 5-year survivors including 11 patients with nodal involvement, 10 with stage I tumors, 13 with stage II tumors, 10 with stage III tu mors, and 2 with stage IV turners. The cumulative 5-year survival rate In patients with stage I tumors was 91% (n = 15), 85% in patients wit h stage II tumors (n = 24), 40% in patients with stage III tumors (n = 28), and 19% in patients with stage IV tumors (n = 39). In patients w ith stage III and IV tumors the 5-year survival rate was 52% after cur ative resection (n = 35). This was significantly better than the 5% 5- year survival rate after a noncurative resection (n = 32). Conclusions . The presence of lymph node metastases is strongly influenced try the depth of invasion of the primary tumor. Accurate determination of the TNM Stage is essential in comparing surgical results, predicting-pati ent outcome, and planning additional treatment. Standard radical surge ry contributes to patient survival and is recommended in patients with advanced GBC.