Primary gallbladder carcinoma: significance of subserosal lesions and results of aggressive surgical treatment and adjuvant chemotherapy.

Advances in methods to diagnose biliary disease have not improved the dismal survival rates reported for primary gallbladder cancer. We analyzed the results of operation in 112 patients with gallbladder cancer. Tumors limited to the gallbladder wall and those that required aggressive surgical therapy and adjuvant chemotherapy for advanced disease were analyzed separately according to the following staging system: tumors that were localized to the mucosa (stage, I, n = 4); tumors that penetrated the muscularis (stage II, n = 4); subserosal tumors (stage III, n = 3); tumors with cystic node involvement (stage IV, n = 13); and tumors that had spread to adjacent organs (stage V, n = 88). Of the 11 patients (10%) with tumor limited to the gallbladder wall (stages I to III), one of five patients (20%) treated with cholecystectomy alone and four of six patients (60%) treated with cholecystectomy and lymphadenectomy (with hepatic wedge resection in three and pancreaticoduodenectomy in one) were alive and tumor free 3 to 6 years after operation. Three patients treated with cholecystectomy alone died of recurrent cancer at 18, 48, and 60 months after operation. Of the 13 patients with cystic node involvement (stage IV), nine were treated by cholecystectomy alone, three with lymphadenectomy, and one with pancreaticoduodenectomy; the cumulative survival rate was only 37% at 6 months, and all patients were dead within 18 months. Of 14 patients with advanced disease (stage V) treated with aggressive surgical therapy, including lymphadenectomy in six patients, hepatic wedge resection in six patients, and right hepatic lobectomy in two patients, the mean survival rate was only 3 months.