Prognostic factors in the surgical treatment of gallbladder carcinoma.

A clinical and pathologic review was undertaken of 36 patients with primary carcinoma of the gallbladder who could tolerate curative resection. The 5-year survival rate of the patients with tumor exposed to the serosa (n = 17) was significantly lower than that of the patients with tumor limited to the mucosa (n = 7), muscularis (n = 7), or subserosa (n = 5). Macroscopically, all tumors limited to the mucosa and 6 of 7 limited to the muscularis were of the papillary form, which was associated with a better patient survival (p less than 0.05) than the nodular or infiltrative form present in 11 of 17 tumors that penetrated to the serosa. The papillary or well-differentiated carcinoma--present in all patients with tumors superficial to the gallbladder subserosa--had a higher survival (p less than 0.001 and p less than 0.01) than the moderately or poorly differentiated carcinoma present in 7 of 17 tumors with spread to the serosa. Incidences of venous, lymphatic, or perineural invasion were higher in tumors that spread beyond the serosa than those limited to the mucosa (p less than 0.05), and survival differed between patients with and without these characteristics (p less than 0.001). Analysis for nuclear DNA pattern of those tumors limited to the mucosa revealed its lower cellular malignancy. Patients with tumors superficial to the subserosa survived longer after undergoing extended cholecystectomy than those who underwent simple cholecystectomy (p less than 0.05). The prognosis of gallbladder carcinoma was highly influenced not only by the biologic nature of tumor but by the surgical procedures used.