Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification

Abstract

Aggressive surgical resection should be considered even in stage IV patients when hepatoduodenal ligament invasion and nodal involvement are absent or limited. Acceptable survival may be expected among such patients only when curative resection is achieved.

Prognostic Factors of Patients with Advanced Gallbladder Carcinoma Following Aggressive Surgical Resection

“…Therefore, despite the fact that complete surgical resection is the only potentially curative treatment option, only a small proportion of patients are candidates for resection. [6][7][8] In order to improve survival of patients with this disease, aggressive surgical procedures including major hepatectomy, pancreatoduodenectomy, [9][10][11][12][13] and extended lymphadenectomy, as well as adjuvant therapeutic modalities including chemotherapy and radiotherapy, [14][15][16][17][18][19][20][21][22] have been advocated by several investigators. However, despite the use of aggressive surgery and adjuvant therapy, the 5-year survival following surgical resection remains low, especially in advanced gallbladder carcinoma.…”

“…However, despite the use of aggressive surgery and adjuvant therapy, the 5-year survival following surgical resection remains low, especially in advanced gallbladder carcinoma. 7,9,10,14,15,[23][24][25][26][27][28][29][30][31][32][33][34][35] Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are necessary to improve long-term survival of patients with gallbladder carcinoma.…”

Expression of hypoxia-inducible factor-1 alpha (HIF-1α) in patients with the gallbladder carcinoma

“…This carcinoma is an aggressive tumor with a poor prognosis because of its inherent biology and often advanced stage at diagnosis [1,2], despite the recent advances in diagnostic modalities [3,4]. Curative surgical approaches remain the principal treatment associated with improvement in 5-year survival rates, but prognosis is closely correlated with the extent of tumor invasion and lymph node metastasis, suggesting survival is stage dependent (if carcinoma remains within the muscle layer and with no lymph node metastasis, the overall 5-year survival rate is about 90%) [5,6].…”

Surgery for gallbladder cancer: The need to generate greater evidence

“…In patients with stage Ⅳ disease, there remain proponents of radical surgery [25,32,33] even in stage Ⅳ disease. However, prior to interpreting these results it must be understood that patients with stage Ⅳa and even b need not have distant metastases.…”

“…However, prior to interpreting these results it must be understood that patients with stage Ⅳa and even b need not have distant metastases. Thus the survival advantage that has been demonstrated [32,33] is primarily in those patients without liver, peritoneal or distant metastases. More robust data is needed to determine whether there exists a survival benefit of radical resections in these patients or, for that matter, even in patients with liver metastases (anecdotal reports exist on the benefit of radical surgery in these patients).…”