The standardized surgical approach improves outcome of gallbladder cancer
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The standardized surgical approach improves outcome of gallbladder cancer Stefan Scheingraber1, Christoph Justinger1, Tatiana Stremovskaia2, Malte Weinrich1, Dorian Igna1 and Martin K Schilling*1 Address: 1Department of General-, Visceral-, Vascular- and Paediatric Surgery, University Hospital, University of the Saarland, D-66421 Homburg, Germany and 2Institute of Pathology, University Hospital, University of the Saarland, D-66421 Homburg, Germany Email: Stefan Scheingraber - [email protected]; Christoph Justinger - [email protected]; Tatiana Stremovskaia - [email protected]; Malte Weinrich - [email protected]; Dorian Igna - [email protected]; Martin K Schilling* - [email protected] * Corresponding author
Published: 21 May 2007 World Journal of Surgical Oncology 2007, 5:55
doi:10.1186/1477-7819-5-55
Received: 4 January 2007 Accepted: 21 May 2007
This article is available from: http://www.wjso.com/content/5/1/55 © 2007 Scheingraber et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. Methods: The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. Results: Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014). The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. Conclusion: Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.
Background In the recent surgical literature therapy of gallbladder cancer (GC), which has traditionally been viewed with therapeutic nihilism, has documented an increase of 5 year survival rates from 5–12% up to 38% [1]. Because the survival of patients treated by palliative chemotherapy or radiation is poor, limited to months, an aggressive approach to locally confined disease is justified. However,
there is considerable controversy what exactly constitutes
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