The Rationality of Resectional Surgery and Palliative Interventions in the Management of Patients with Gallbladder Cancer METIN ERCAN, M.D.,* ERDAL B. BOSTANCI, M.D.,* TEBESSUM CAKIR, M.D.,† KEREM KARAMAN, M.D.,* ILTER OZER, M.D.,† MURAT ULAS, M.D.,† TAHSIN DALGIC, M.D.,† YUSUF OZOGUL, M.D.,† EROL AKSOY, M.D.,† MUSA AKOGLU, M.D.* From the *Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey and †Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey The aim of the present study was to evaluate in a retrospective manner, the survival period and survival rate according to stages and groups after R0, R1, R2 resections and palliative in- terventions. Between 2003 and 2012, 67 patients diagnosed with gallbladder carcinoma were ret- rospectively analyzed. Patient demographics, the survival period, and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions were retrospectively analyzed. Sixty-seven patients were diagnosed with gallbladder carcinoma. Thirty-eight patients (56.7%) were female and 29 patients (43.3%) were male. The median survival period was signifi- cantly longer in stage II and III diseases than in stage IV disease (P < 0.001). The R0, R1, and R2 resection rates in patients who underwent surgery with curative intent were 67.7, 19.4, and 12.9 per cent, respectively. The R0 resection rate according to the tumor stages was 100 per cent for stage I, 87.5 per cent for stage II, 66.7 per cent for stage III, and 42.8 per cent for stage IV disease. The median follow-up period was six months (eight days to 36 months). During this follow-up period, 53 patients (79.1%) died. In conclusion, R0 resection rate decreases when tumor stage increases. The highest survival rates after R0 resection are achieved in patients with stage I, II, and III diseases. Radical surgery has no benefit over palliative surgery for stage IV disease in terms of survival. G ALLBLADDER CANCER IS the fifth most common cancer involving the gastrointestinal tract, and the most common cancer of the biliary tract. 1 Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and poor prognosis. The tumor- node-metastasis stage is the most important prognostic factor affecting survival. 2 – 4 Long-term survival is only possible when curative resection can be done in early stages. 3 – 7 Cholecystectomy is quite sufficient for T1s and T1a gallbladder carcinomas. On the other hand, T1b and deeper cancers beyond the gallbladder wall require more aggressive surgery. Surgical resection for advanced gallbladder cancers is recommended only if a potentially curative R0 resection is possible. 7 R0 resection (surgical resection of the tumor mass with negative margins) seems to be the only effective treatment to prolong survival, and long-term survival is not expected in patients who underwent R1 (macro- scopic removal of the tumor with positive microscopic margins) or R2 (incomplete macroscopic removal of the tumor) resections. 3 Choi et al. 6 found in their series that R0 resection was the most important factor to prolong survival in T2 stage tumors. R0 resection should be the primary goal in all pa- tients staged resectable before surgery. 8 However, he- roic resections in patients with highly advanced cancer disease or severe accompanying nontumor diseases are not recommended. 9 Radical cholecystectomy is the optimal treatment option for resectable gallbladder cancer. 10 This in- cludes cholecystectomy, liver resection (wedge re- section, segment IVb + V resection, or extended right hepatectomy), and regional lymphadenectomy along the hepatoduodenal ligament, behind the duodenum and pancreatic head, common hepatic artery, and ce- liac axis. Although aggressive surgery including vas- cular and multivisceral resection has been shown to be This article was presented by Metin Ercan as oral presentation in September 2013 in Cyprus at the First Turkish National Gastrointestinal Surgery Congress. Address correspondence and reprint requests to Metin Ercan, M.D., Arabacıalanı mah. Eski Kazımpasa Cad. 570 sok. Saklıbahce Konutları F Blok Daire 8, Serdivan, 54050 Sakarya, Turkey. E-mail: metinercan66@mynet.com. 591