Do recent advances in diagnosis and operative management improve the outcome of gallbladder carcinoma?

Abstract

To study the effect of recent advances in diagnosis and operative management on survival of patients with gallbladder carcinoma, records of 26 patients who underwent resection between 1960 and 1978 (group 1) and 25 patients who underwent resection between 1979 and 1991 (group 2) were compared. The operative mortality rate was lower in group 2 (0%) than in group 1 (12%). The 5-year survival rate was higher in group 2 (60.8%) than in group 1 (30.4%; p < 0.01). Although preoperatively undiagnosed cases were not less in group 2 than in group 1, cases diagnosed with certainty before surgery were increased significantly and suspected cases of gallbladder carcinoma were decreased in group 2 (p < 0.05) as a result of recent advances in hepatobiliary imaging techniques. Twenty patients in group 2 (80%) and 13 in group 1 (50%) had tumors less than 30 mm in diameter (p < 0.05). Nine patients in group 2 (36%) had tumors at an early stage (tumors limited to mucosal or muscular layer), and only two (8%) in group 1 had early-stage tumors (p < 0.05). The incidence of curative resection was higher in group 2 (76%) than in group 1 (27%; p < 0.001). Earlier diagnosis and a higher chance of curative resection, together with improved surgical techniques, may contribute to the better survival seen in the recent 12-year period.