FEATURE An Aggressive Surgical Approach Leads to Improved Survival in Patients With Gallbladder Cancer

Objective: To determine if an aggressive surgical approach, with an increase in R0 resections, has resulted in improved survival for patients with gallbladder cancer. Summary Background Data:Many physicians express a relatively nihilistic approach to the treatment of gallbladder cancer; consensus among surgeons regarding the indications for a radical surgical approach has not been reached. Methods: A retrospective review of all patients with gallbladder cancer admitted during the past 12 years was conducted. Ninety-nine patients were identified. Cases treated during the 12-year period 1990 to 2002 were divided into 2 time-period (TP) cohorts, those treated in the first 6 years (TP1, N 35) and those treated in the last 6 years (TP2, N 64). Results: Disease stratification by stage and other demographic features were similar in the 2 time periods. An operation with curative intent was performed on 38 patients. Nine (26%) R0 resections were performed in TP1 and 24 (38%) in TP2. The number of liver resections, as well as the frequency of extrahepatic biliary resections, was greater in TP2 (P 0.04). In both time periods, an R0 resection was associated with improved survival (P 0.02 TP1, P 0.0001 TP2). Overall survival of all patients in TP2 was significantly greater than in TP1 (P 0.03), with a median survival of 9 months in TP1 and 17 months in TP2. The median 5-year survival in TP1 was 7%, and 35 % in TP2. The surgical mortality rate for the entire cohort was 2%, with a 49 % morbidity rate. Conclusions: A margin-negative, R0 resection leads to improved survival in patients with gallbladder cancer