Aggressive Surgery for Locally Advanced Gallbladder Cancer with Obstructive Jaundice: Result of a Prospective Study

OBJECTIVE: The aim of this study was to clarify the clinical impact of our departmental policy for advanced gallbladder cancer (GBC) even with obstructive jaundice. METHODS: Obstructive jaundice was defined as serum T-bil ≥2.0 mg/dl. Between 1998 and 2008, 112 patients with GBC were scheduled for surgical resection with curative intent. Thirty-six patients were converted to palliative surgery or exploration alone because of advanced disease. After excluding pathological T1 (UICC) patients (n = 11), the remaining 65 patients were divided into 2 groups; jaundiced group (n = 37) and non-jaundiced group (n = 28). Surgical procedures were conducted based on our departmental guidelines concerning each type of infiltration of GBC. RESULTS: Bile duct resection and major hepatectomy were performed more frequently in patients with jaundice. Although patients in jaundiced group had more advanced disease, 5-year overall survival rates of the patients with or without jaundice were 27 vs. 31% (p = 0.742), which was not statistically significant. CONCLUSIONS: Aggressive surgery might improve long-term survival in patients with locally advanced GBC even in the condition of obstructive jaundice with no distant metastasis.