Background: Gallbladder cancer (GBC) is an aggressive and an uncommon malignancy with overall dismal outcome. There have been only few studies examining the epidemiology, surgical outcomes and survival of GBC.Aim: To examine the demographic characteristics, pathology, surgical outcomes and survival of patients with GBC in a tertiary care center.
Methods: Patients diagnosed with primary GBC were identified from the WVU cancer registry. Cases were arbitrarily divided into pre-laparoscopic (1985-1995) and laparoscopic era (1996-2006). Information on demographics, symptoms, clinical staging, treatment modality, surgical procedures with outcomes and survival were obtained.
Results: A total of 47 cases were identified with 40 (85%) female and 7 (15%) male (p< 0.001). Average age was 66 years (37-85, median 68). 42 (90%) were white in the patient cohort. 39 (83%) patients had cholelithiasis and 32 (68%) had cholecystitis. Abdominal pain (85%) and nausea (81%) were the most common symptoms at presentation. 24 (51%) patients had jaundice at initial presentation and of these 15 (63%) had ERCP. US and CT were the most common initial modalities for evaluation. Of the cases where the type of cancer was reported, 39 (83%) patients had adenocarcinoma with 17 (36%) moderately differentiated and 30% (14) poorly differentiated cancer, 2 (4%) had squamous cell carcinoma, one small cell and one histiocytoma. Although the complication rate with attempted laparoscopic surgery was high, it did not affect the median survival when compared with open cholecystectomy. 30% (14) of patients had curative surgery and 45% (21) had palliative surgery. 51% (24) of patients were treated with chemotherapy, 32% (15) with radiation and 30% (14) with combination chemotherapy and radiation therapy. In the two eras we see a trend in improved survival (28 wks vs. 41 wks) that is statistically significant (Table).
Conclusions: Our 22 year experience showed that significantly more patients were diagnosed with GBC in the laparoscopic era. Even though the outcomes are dismal, there is a trend of significant increase in stage specific and overall survival over the last two decades.
GBC in pre-laparoscopic (1985-1995) and laparoscopic (1996-2006) era

	Pre-lap era	Lap era	P-value
No of patients, n (%)	14 (30)	33 (70)	< 0.001
Incidental open cholecystectomy, n (%)	10 (71)	6 (18)	< 0.01
Incidental laparoscopic cholecystectomy, n (%)	0 (0)	20 (82)	< 0.0001
Stage I/II/III, n (%)	4 (29)	10 (30)	NS
Stage IV, n (%)	10 (71)	23 (70)	NS
Stage I/II/III survival (wk)	379/-/42	450/67/58	< 0.001
Stage IV survival (wk)	23	37	< 0.001
Overall survival (wk)	28	41	< 0.001