Introduction: Questions remain regarding the proper surgical treatment of gallbladder carcinoma (GBCa) when diagnosed at the time of cholecystectomy (chole).
Methods: A retrospective review of all patients with GBCa treated at our institution between 1989-2000 was performed. These patients received at least one of the following treatments: chole only, radical resection (RR = wedge resection of the gallbladder bed and lymphadenectomy of the portal and celiac nodes), or palliative surgery (PS = enteric and/or biliary bypass/stent). Outcomes based on initial pathologic tumor stage after chole (rather than final TNM stage) and method of treatment were obtained using Wilcoxon rank sum and Kaplan-Meier analyses.
Results: The 53 GBCa patients identified were an average 66±13 years old and were 68% female, 85% white and 15% black. Morbidity after RR was low (SVT in 2 patients), and there were no peri-operative deaths. See table for outcome results.
Conclusions: Survival for patients with pT1 GBCa who underwent chole alone was good, but they also had a high recurrence rate (25%). RR may be indicated for pT1 GBCa given this recurrence rate. For patients with pT2 and pT3 GBCa, RR significantly improved mean survival over chole alone. RR therefore is strongly recommended for patients with pT2 and pT3 GBCa . The overall prognosis of patients with pT4 GBCa was poor with any method of treatment.
Outcome by GBCa Tumor Stage
Tumor Stage Procedure (n) Mean survival (months±SD) % tumor recurrence
pT1 chole (4) 54.1±38.5 25%
pT2 chole (6) 21.9±14.5* 66%
pT2 chole+RR (6) 40.2±29.6* 0%
pT3 chole (10) 8.1±5.9 90%
pT3 chole+RR (3) 18.0±9.0 66%
pT4 chole (8) 7.5±5.3 N/A
pT4 chole+RR (2) 9.0±1.4 N/A
pT4 PS (14) 2.6±2.5 N/A
*, p<0.05, NS, N/A=not applicable
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