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Treatment of T3 and T4 carcinomas of the gallbladder.

Forty-nine patients with T3 and T4 carcinoma of the gallbladder were treated by three different regimens. Group 1 consisted of 26 patients treated with combined resection alone; group 2 was twelve patients whose tumors had spread to the hepatoduodenal ligament treated with combined resection plus intraoperative radiation therapy; group 3 comprised eleven patients with nonresectable tumors treated with hyperthermia in combination with chemoradiation therapy (HCRT). The difference in the survival rates between group 1 and 2 were statistically significant (p < 0.001); however, the difference between group 2 and 3 was not significant. In group 1, there was a significant difference between patients with and without lymph node involvement in the 3-year survival rate (p < 0.01). Thus, the only patients without involvement of regional lymph nodes and the hepatoduodenal ligament have the best potential for long-term survival through aggressive surgical approaches. HCRT may provide an alternative palliation for patients with advanced carcinoma showing obstructive jaundice.