Prognostic factors for gallbladder cancer in the laparoscopy era.
10.4174/jkss.2012.83.4.227
- Author:
Hak Youn LEE
1
;
Young Hoon KIM
;
Ghap Joong JUNG
;
Young Hoon ROH
;
Si Young PARK
;
Nam Uk KANG
;
Soon Hwa YOON
;
Jin Han CHO
;
Myung Hwan ROH
;
Sang Young HAN
;
Sung Wook LEE
;
Yang Hyun BAEK
;
Jin Sook JEONG
Author Information
1. Department of Surgery, Dong-A University College of Medicine, Busan, Korea. yhkim1@dau.ac.kr
- Publication Type:Original Article
- Keywords:
Gallbladder cancer;
Laparoscopy;
Prognosis
- MeSH:
Bile;
Biology;
Cholecystectomy, Laparoscopic;
Cohort Studies;
Drainage;
Early Diagnosis;
Gallbladder;
Gallbladder Neoplasms;
Humans;
Laparoscopy;
Lymph Nodes;
Multivariate Analysis;
Prognosis;
Retrospective Studies;
Survival Rate
- From:Journal of the Korean Surgical Society
2012;83(4):227-236
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Hepatobiliary surgery has changed dramatically in recent decades with the advent of laparoscopic techniques. The aim of this retrospective study was to compare survival rates according to stages, adjusting for important prognostic factors. METHODS: A retrospective study of a 17-year period from January 1994 to April 2011 was carried out. The cases studied were divided into two time period cohorts, those treated in the first 9-years (n = 109) and those treated in the last 7-years (n = 109). RESULTS: An operation with curative intent was performed on 218 patients. The 5-year survival rates according to the depth of invasion were 86% (T1), 56% (T2), 45% (T3), and 5% (T4). The number of cases of incidental gallbladder cancer found during 3,919 laparoscopic cholecystectomies was 96 (2.4%). Incidental gallbladder cancer revealed a better survival rate (P = 0.003). Iatrogenic bile spillage was found in 20 perforations of the gallbladder during laparoscopic cholecystectomies, 16 preoperative percutaneous transhepatic gallbladder drainages and 16 percutaneous transhepatic biliary drainages; only percutaneous transhepatic biliary drainage patients showed a significantly lower survival rate than patients without iatrogenic bile spillage (P < 0.034). Chemoradiation appeared to improve overall survival (P < 0.001). Multivariate analysis also revealed that time period, type of surgery, surgical margin, lymphovascular invasion, lymph node involvement, and chemoradiation therapy had significant effects. CONCLUSION: This study found that the prognosis of gallbladder cancer is still determined by the stage at presentation due to the aggressive biology of this tumor. Early diagnosis, radical resection and appropriate adjuvant therapy can increase overall survival.
