Primary carcinoma of the gallbladder.

The clinical records of 48 patients with primary carcinoma of the gallbladder seen at the Dartmouth-Hitchcock Medical Center over the past 25 years were reviewed. Of the 37 patients with unresected tumors, there were no survivors. Of the 11 patients with resected tumors, one survived five years, two died before five years without evidence of recurrence, and the remainder died with locally recurrent tumor. This experience reemphasizes the inadequacy of the present surgical approach to the disease. The tendency of carcinoma of the gallbladder to spread initially by local invasion of the liver bed and by metastases to regional lymph nodes has often been neglected by those treating the disease. Wedge resection of the liver and regional lymphadenectomy in addition to cholecystectomy are theoretically advantageous and should be striven for in the case of resectable tumors, even if reoperation is required.