Premium
Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications?
Author(s) -
Nishio Hideki,
Nagino Masato,
Ebata Tomoki,
Yokoyama Yukihiro,
Igami Tsuyoshi,
Nimura Yuji
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1187-0
Subject(s) - medicine , paraaortic lymph nodes , metastasis , contraindication , carcinoma , surgery , stage (stratigraphy) , gallbladder , survival rate , oncology , radiology , cancer , pathology , alternative medicine , biology , paleontology
Background/Purpose Advanced gallbladder carcinoma with paraaortic lymph node metastasis or distant metastasis is normally considered a contraindication for surgery. Our latest analyses suggest otherwise. Methods Records of 166 patients who underwent surgery for stage IV gallbladder carcinoma were reviewed retrospectively. Predictors of hospital mortality and long‐term survival were analyzed. Long‐term survival in patients with paraaortic lymph node metastasis and/or distant metastasis was also determined. Results Fifteen patients were 5‐year survivors, with a 5‐year survival rate of 12% among the 166 patients investigated. Overall hospital mortality was 14%. Male sex and portal vein resection were independent predictors of hospital mortality. Multivariate analysis of long‐term survival failed to identify independent predictors. Patients with distant metastasis were divided into two groups based on whether or not the metastases were distant from the liver. Patients with paraaortic lymph node metastasis who underwent curative resection or who had isolated liver metastasis survived longer than those with other distant metastasis or those with unresectable advanced cancer. Conclusions Patients with advanced gallbladder carcinoma can benefit from surgical resection even when paraaortic lymph node metastasis and/or liver metastasis are present. However, surgical indications in advanced disease should be determined on an individual basis, based on clinical status.