Retrospective analysis of 70 operations for gallbladder carcinoma

Background The clinical course of patients with carcinoma of the gallbladder depends on the depth of tumour invasion. This study was conducted to clarify the prognostic factors affecting survival and appropriate surgical strategy based on depth of invasion of gallbladder carcinoma according to the pathological tumour node metastasis (pTNM) classification. Methods A total of 70 patients who underwent surgical resection were reviewed retrospectively with regard to the type of operation, histopathological findings of the resected gallbladder carcinoma and clinical follow-up after operation. Results Twelve patients with pT(1) gallbladder carcinoma fared favourably following cholecystectomy or extended cholecystectomy, In 13 of 26 patients with pT(2) gallbladder carcinoma, lymph node metastasis was evident: pN(1) in eight and pN(2) in five. The 3-year survival rate of patients with pT(2) gallbladder carcinoma was 28 per cent after cholecystectomy, 91 per cent after extended cholecystectomy and 67 per cent after hepatectomy. In 21 of 28 patients with pT(3) or pT(4) gallbladder carcinoma, surgical margins were affected by malignant cells, The I-year survival rate of patients with pT(3) or pT(4) gallbladder carcinoma was 24 per cent, even after hepatectomy. Significant prognostic factors were age, macroscopic type, histological grade, depth of invasion, lymph node metastasis, pathological stage, lymphatic invasion, venous invasion, perineural invasion and involved surgical margins. Conclusion Cholecystectomy was adequate for pT(1) gallbladder carcinoma. Extended cholecystectomy or hepatectomy with extrahepatic bile duct resection and lymph node dissection (pN(1) and pN(2)) were justified for pT(2) gallbladder carcinoma. The survival of patients with more advanced gallbladder carcinoma remains dismal.