Trimodality therapy for advanced gallbladder cancer

We conducted a retrospective review of all patients who underwent surgical extirpation for stage III, stage IV, or recurrent carcinoma of the gallblad der. Between 1991 and 1999 ten patients underwent surgical resection for ad vanced gallbladder cancer. All patients received adjuvant therapy either pr e- or postoperatively. Radiotherapy was used in all patients and chemothera py in 90 per cent of patients. Two patients subsequently underwent resectio n for locally recurrent disease. An additional patient with stage II diseas e initially was also treated surgically for a local recurrence. Surgical ma nagement involved cholecystectomy and resection of various amounts of liver surrounding the gallbladder bed and regional lymphadenectomy. Contiguously involved structures were resected en bloc. Resection of recurrent disease included excision of all gross tumor. The median overall survival excluding the one 30-day mortality was 53.6 months (range 8-73 months). Four patient s have survived 4 or more years, and currently four patients are alive and disease free at 73, 49, 33, and 8 months. Median disease-free interval afte r each resection of recurrent disease was 13.8 months (range 4-28 months). We conclude that trimodality therapy in selected patients with stage III, I V, or recurrent carcinoma of the gallbladder is possible and may result in prolonged survival.