LONG-TERM RESULTS AFTER RESECTION FOR GALLBLADDER CANCER - IMPLICATIONS FOR STAGING AND MANAGEMENT

Background The surgical management of gallbladder cancer is controvers ial. There is no consensus among surgeons as to the indications for re operation or radical resection. Objective The purpose of this study wa s to examine results of reoperation after an incidental finding of gal lbladder cancer after cholecystectomy, and results of radical resectio n in patients with advanced disease. Methods A retrospective review of 149 patients with the diagnosis of gallbladder cancer treated from 19 85 to 1993 was performed. Fifty-eight patients were explored and 23 un derwent resection for cure. Resection included trisegmentectomy in nin e patients and bite duct resection in ten patients. Seventeen patients underwent re-exploration after an incidental finding of gallbladder c ancer at initial cholecystectomy. Results Surgical resection is associ ated with an actuarial 51% 5-year disease-free survival rate,with a me dian follow-up time of 48 months. Eight patients are alive beyond 50 m onths. There were no operative deaths; the perioperative morbidity rat e was 26%. Nodal status is the most powerful predictor of outcome. Two patients with T4, N0 disease are alive without evidence of disease be yond 4 years. Thirteen of the 17 patients (76%) undergoing reoperation after simple cholecystectomy for T2 or T3 tumors had residual disease . Conclusions Patients with nodal metastasis beyond the pericholedocha l nodes should not be considered for curative resection. Tumors staged T4, N0 should be included with stage III disease, and resection shoul d be considered. Re-resection of T2 or T3 tumors after simple cholecys tectomy is likely to include residual disease and should thus provide the only chance for long-term survival.