Does aggressive surgical resection improve the outcome in advanced gallbladder carcinoma?

BACKGROUND/AIMS: Patients with advanced gallbladder carcinoma have usually been considered nonresectable, leading to a very poor outcome. This study w as aimed to evaluate the results of our aggressive surgical approaches in c ertain cases of advanced gallbladder carcinoma. METHODOLOGY: Ninety-one patients with advanced gallbladder carcinoma of sta ges pT3 and pT4 who underwent surgery at our institution were the subjects of this study. Fifty-eight of 91 patients had surgical excision; 44 by hepa tic resection and 14 by hilar resection. Post-operative outcome was evaluat ed. Advanced gallbladder carcinomas were classified according to our previo usly reported classification: type I hepatic; type II biliary; type III hep atobiliary; type IV others. RESULTS: Curative resection was obtained act a more increased rate in type I tumor patients than in types II and III (91% vs. 29%, p<0.01). The surgic al mortality rate was 17%. Survival rates of resected patients were signifi cantly higher that those of nonresected patients: 45%, 31%, 22%, 17%, 13% a t 1, 2, 3, 4, 5 years vs. 9%, 9%, 0% at 1, 2, 3 years (p<0.01). Survival ra tes of type I tumor patients after curative resection were remarkably highe r than those of type II and III tumor patients, (69%, 64%, 56%, 48%, 39% at 1, 2, 3, 4, 5 years vs. 17%1 17%, 0% at 1, 2, 3 years). CONCLUSIONS: Aggressive surgical approaches might bring about improved prog nosis in advanced gallbladder carcinoma, especially for patients with type I tumors.