Validation of revised american joint committee on cancer staging for gallbladder cancer based on a single institution experience.

University of California, Irvine Medical Center, Orange, California, USA.
The American surgeon (Impact Factor: 0.92). 10/2013; 79(10):1045-9.
Source: PubMed

ABSTRACT Gallbladder cancer is a rare malignancy, which often goes undiagnosed until advanced stages of disease and is associated with poor prognosis. The only potentially curative treatment is surgical resection. This retrospective study aims to investigate the validity of the revised 7th edition American Joint Committee on Cancer staging criteria and determine prognostic factors. Forty-two patients with confirmed gallbladder cancer who underwent attempted curative resection from 1999 to 2012 at the University of California, Irvine Medical Center were reviewed. Survival probability was determined using the Kaplan-Meier method. Ten patients underwent laparoscopy, were deemed unresectable, and no further surgical intervention was performed. R0 surgical resection, which included radical portal lymphadenectomy, liver segment IVb/V resection, with or without bile duct resection, was performed in the remaining 32 patients. N2 nodes were resected if positive on frozen section. Overall survival probability for Stage I to II patients was 100 per cent. Overall survival probability for Stage III patients was 80 per cent (95% confidence interval [CI], 61 to 99%) and 39.3 per cent (95% CI, 28 to 78%) for Stage IV patients. This study demonstrates that 7th edition clinical stage, T stage, and liver involvement are statistically significant predictors of prognosis. These data also demonstrate a benefit to extended resection in patients even with Stage III and IV disease.

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    ABSTRACT: To discuss some key issues involved in the management of gallbladder cancer (GBC). The decline in incidence and mortality of GBC began decades before the introduction of laparoscopic surgery. In consecutive autopsies and in cases in which cholelithiasis was present, the incidence of gallbladder carcinoma is 3-4%. A number of genetic alterations have been identified in the different stages of GBC and they support the morphological evidence of two pathways by which tumors develop. Some of these genetic changes are associated with particular risk factors. All management of GBC and all comparisons of treatment results from different centers must be based on the stages. Simple cholecystectomy is the adequate treatment for T1a GBC. Lymph node excision improved survival in patients with T2 lesions. Radical en bloc resection of T2 tumors offers greater benefit over conventional cholecystectomy alone in terms of greater long-term survival times. Provided that negative surgical margins are secured, hepatectomy and lymph node resection can, therefore, be withheld in most cases in the surgical treatment of pT2 GBC. With improvements in surgical and anesthetic techniques, aggressive surgery has proven to be performed with safety.
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