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Introduction: Gallbladder cancer has a five year survival rate of <5% for those not amenable to surgery. Even patients undergoing radical surgical resection, the median survival is 35% for all stages. The study’s aim was to highlight any survival improvement with changing neoadjuvant/adjuvant regimens over the last 20 yearsMethods:Patients with Gallbladder cancer were reviewed from our tumor registry between 1990-2008. Stages were assigned by AJCC 6th edition; survival curves were compared over a split period from 1990-2000 & 2000-2008.Results:94 patients with gallbladder cancer were analyzed.42 patients were stratified 1990-2000, and 52 patients from 2000-2008. Average age between the decades was not significant. (64vs59, P=NS) 91% of the patents underwent surgery(n=83). 51% of that group had laparoscopic cholecystectomy(n=43) and 13% had an open cholecystectomy(n=11) as initial surgery . 76% of the group having laparoscopic cholecystectomy necessitated further operative intervention(n=33), with 36% being staged three or greater(n=12) (p<0.05). Of the laparoscopic cholecystectomy group, 23% presented with port site metastasis at definitive surgery(n=10). 48% underwent bisubsegemental resection and portal lymphadenectomy(n=40). 15% had a common bile duct resection added to their liver bed resection(n=13) and 7% necessitated enbloc colectomy for intraoperative recognized T4 disease(n=6). 30% of those who had their bile duct resection had their procedure in the earlier decade (n=4,p< 0.14); no survival difference noted in this subset of patients between decades. No significance was noted in stage separation of the two decades (P<0.988). Majority of the patients (n=20 vs 26) were stage 4. Kaplan Meier calculated survival curves note no stage differences between the respective decades.Conclusion: No change is noted in survival by stage despite shifting from an adjuvant to neoadjuvant paradigm. With laparoscopic cholecystectomy, the identification of incidental gallbladder carcinoma has increased dramatically. Despite gallbladder cancer being discovered incidentally prognosis varies and extended resection is often necessary.

Specifics	1990-2000 n=42	2000-2008 n= 52
No. Neodjuvant Therapy	7	29 p,0.001
No. Adjuvant therapy	27	22 p=0.027
No. Neoadjuvant & Adjuvant therapy	0	6 p=0.03
Chemotherapy alone	1 (neo-adj)9 (adj)	7(neo-adj)12(adj)
Radiation alone	4(neo adj)3(adj)	10(neo-adj)1(adj)
Port site recurrence	9	1 p<0.05
Laporoscopic Cholecystectomy	20	23