Outcomes of aggressive treatment of stage IV gallbladder cancer and predictors of survival

BACKGROUND/AIMS: Stage TV gallbladder carcinoma patients are rarely conside red treatable by resection. They resign themselves to palliation because th ere is no long-term survival data available on the risks of morbidity and m ortality following aggressive treatment. The aim of this study was to evalu ate predictors of survival following aggressive resection surgery for stage IV gallbladder carcinoma. METHODOLOGY: In this retrospective study, we examined 93 patients with stag e IV gallbladder carcinoma who bad undergone resections. Of the 93 patients , 69 had undergone liver resection to various extents together with hepatic ocholedochus resection (HCR); 2 had undergone pancreaticoduodenectomy (PD) both with and without HCR; 31 had undergone hepatopancreaticoduodenectomy ( HPD); 7 had undergone cholecystectomy together with HCR; 12 had undergone c holecystectomy; and 3 had undergone extended cholecystectomy. Fifty of the 93 patients had also undergone adjuvant radiotherapy. Using univariate and multivariate analyses, 13 clinicopathologic risk factors were analyzed to p redict; survival. RESULTS: Operative morbidity and mortality rates were 17.2% and 5.4%, respe ctively. Overall, the 5-year survival rate and median survival time were 9. 8% and 243 days, respectively. The 5-year survival rate was significantly h igher in stage IVA (n=17) than in stage IVB (n=76), at 42.8% and 4.9%, resp ectively. Multivariate analysis revealed that sex, histopathologic type, ly mph node involvement (N), subgroup of stage IV, post-resection residual tum ors, and adjuvant radiotherapy were significant, predictors of survival. CONCLUSIONS: Long-term survival, with acceptable mortality and morbidity, c an be expected in female patients who have stage TVA gallbladder cancer con sisting of well-differentiated adenocarcinoma and who undergo either comple te microscopic resection or grossly complete resection followed by adjuvant radiotherapy.