Document Detail

Gallbladder cancer involving the extrahepatic bile duct is worthy of resection.
MedLine Citation:
PMID:  21490453     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To clarify the value of resection of gallbladder cancer involving the extrahepatic bile duct.
BACKGROUND: : Several recent studies have proven that jaundice and extrahepatic biliary involvement are independent predictors of a poor outcome. Only a few authors recommend resection of such advanced disease.
METHODS: One hundred patients with pT3/4, pN0/1, M0 disease were the subjects of this study. Mortality and long-term outcome were analyzed using a prospectively collected database.
RESULTS: The only factor associated with mortality in univariate and multivariate analyses was intraoperative blood loss. The 5-year survival rate and median survival time were 23% and 1.5 years for patients with pathologic extrahepatic biliary invasion (pEBI), and 54% and 15.4 years for patients without pEBI. Twelve patients with pEBI survived beyond 5 years. Multivariate analysis revealed that R1/2 resection and combined resection of adjacent organs other than the liver and extrahepatic bile duct (CRAO) were independent predictors of poor outcome. Five-year survival rate and median survival time after R0 resection without CRAO were 36% and 3.8 years even in patients with pEBI. In contrast, after R0 resection with CRAO 5-year survival and median survival time were 16% and 0.8 years, respectively.
CONCLUSIONS: Patients with advanced gallbladder cancer with pEBI are candidates for resection when distant metastases are absent and R0 resection is achievable. When CRAO is unnecessary, surgical resection should be aggressively planned.
Hideki Nishio; Tomoki Ebata; Yukihiro Yokoyama; Tsuyoshi Igami; Gen Sugawara; Masato Nagino
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  253     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-14     Completed Date:  2011-06-23     Revised Date:  2013-07-30    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  953-60     Citation Subset:  AIM; IM    
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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MeSH Terms
Aged, 80 and over
Analysis of Variance
Bile Duct Neoplasms / mortality,  secondary*,  surgery*
Bile Ducts, Extrahepatic / surgery*
Cholecystectomy / adverse effects,  methods*
Disease-Free Survival
Follow-Up Studies
Gallbladder Neoplasms / mortality*,  pathology,  surgery*
Jaundice, Obstructive / pathology,  surgery
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness / pathology
Neoplasm Staging
Postoperative Complications / physiopathology,  surgery
Proportional Hazards Models
Prospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Analysis
Time Factors
Treatment Outcome
Comment In:
Ann Surg. 2013 Jul;258(1):e10-1   [PMID:  23728286 ]
Ann Surg. 2012 Jun;255(6):e20; author reply e21   [PMID:  22566023 ]
Ann Surg. 2013 Jul;258(1):e12   [PMID:  23728287 ]

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