Predictors of Survival in Patients with
Carcinoma of the Gallbladder W e read with interest the article by Pradeep et al. 1 evaluating the outcome of 87 patients with gallbladder carcinoma (GBC) who underwent surgery. The authors concluded that surgical resection provides significantly better survival than a bypass procedure or exploratory laparotomy alone. Because radical tumor resection may significantly improve survival as compared with more conservative procedures, 2-6 we also advocate radical resection for the treatment of this disease. [4][5][6] Pradeep et al. reported that resection improved the survival of patients with American Joint Committee on Cancer (AJCC) Stage IV disease. 7 These data, however, should be interpreted with caution. In their series, the specific procedure chosen was the surgeon's personal preference. AJCC Stage IV disease is a broad category that includes regional and distant metastases. Thus, it may be true that resection was selected for stronger patients with less invasive disease and palliative procedures were performed on sicker patients. This selection bias may have influenced postoperative survival. We do not believe that a simple cholecystectomy, the most common resection in their series, would have affected survival in patients with Stage IV disease.
Furthermore, Pradeep et al. recommended that resection be performed for patients with GBC even if it is noncurative. We believe that this recommendation may be misleading, as curative resection may be a prerequisite for long term survival. [2][3][4][5][6] Of 108 patients we treated with radical resection, no patients with residual tumor survived longer than 5 years (unpublished data). Gall et al. 3 also reported poor survival after palliative resection (median, 5 months). In addition, Bloechle et al. 2 reported that patients with residual tumor survived no longer than 2 years. These data do not support radical resection for GBC patients unless it is curative.