HYPOTHESIS: Precise preoperative staging for @entity1086 is difficult, despite recent advances in hepatobiliary imaging. However, the most accurate preoperative staging may be possible by integrating preoperative key data. OBJECTIVE: To establish useful strategies for the surgical treatment of @entity1086 based on information available before resection. DESIGN: Retrospective review. SETTING: University hospital and @entity5 center. @entity1 AND METHODS: From January 1, 1978, through March 31, 2001, 152 @entity1 with @entity1086 underwent surgical resection with curative intent. Preoperative diagnoses of the T factor ( @entity2996 ) and N factor (image-N) in the @entity2802 classification were determined by evaluating all findings of diagnostic imaging, including ultrasonography, enhanced computed tomography, endoscopic ultrasonography, and angiography. The distribution of lymph node @entity3 and prognostic factors were also analyzed. RESULTS: The overall diagnostic accuracy for @entity2996 was 52.6% (95% confidence interval, 44.7%-60.6%) and was lower in @entity1 with @entity2558 and pT2 disease (37.2% and 33.9%, respectively). However, @entity2996 was a significant predictor of lymph node @entity3 and @entity1 outcome. Preoperative staging for N was more difficult, with only 24.5% (95% confidence interval, 12.4%-36.5%) of the node-positive @entity1 being correctly diagnosed. An analysis of harvested lymph nodes showed that the cystic, pericholedochal, and posterosuperior peripancreatic nodes were the most prevalent sites of @entity3 , and these were considered key nodes for the lymphatic spread of @entity1086 . By combining data on @entity2996 and positivity of these key nodes, more accurate @entity2802 staging was possible. Although an extended lymph node dissection provided significantly better survival in @entity1 with pN2 disease, there was no survival advantage to more radical operations, including bile duct resection or pancreaticoduodenectomy. CONCLUSIONS: Although precise preoperative @entity2802 staging for @entity1086 was difficult, the most accurate staging before resection was possible by integrating @entity2996 classification and data from the intraoperative histopathologic examination of key lymph nodes. Based on this staging, we propose algorithms for the surgical treatment of @entity1086 .

Strategies for surgical treatment of XXXX based on information available before resection.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'PATIENTS'] @entity2558 :: ('58492', 'Gene') :: ['pT1'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tertiary referral cancer'] @entity2802 :: ('10178', 'Gene') :: ['TNM'] @entity2996 :: ('MESH:C564543', 'Disease') :: ['image-T'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis'] @entity1086 :: ('MESH:D005706', 'Disease') :: ['gallbladder cancer', 'gallbladder carcinoma']
@entity1086 :: (MESH:D005706,Disease) :: ['gallbladder carcinoma']
