Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years

Vascular ◽  
2021 ◽  
pp. 170853812110564
Author(s):  
Alessandro Ucci ◽  
Alessandro de Troia ◽  
Rita Maria D’Ospina ◽  
Giuseppe Pedrazzi ◽  
Bilal Nabulsi ◽  
...  
Keyword(s):  
Survival Rate ◽  
Carotid Endarterectomy ◽  
Risk Score ◽  
Length Of Hospital Stay ◽  
Relative Survival ◽  
Lower Percentage ◽  
Chronic Obstructive ◽  
Younger Patients ◽  
Secondary Endpoints

Background The following study investigated the 30-day and 5-year relative survival rate and freedom from neurological events in asymptomatic carotid stenosis (ACS) octogenarians who had undergone elective carotid endarterectomy (CEA). Methods Between January 2008 and June 2014, a retrospective review was conducted on ACS patients who had undergone elective CEA. The patients’ sample was divided into two groups: Group A (GA) included octogenarians and Group B (GB) included younger patients. The GA patients were subjected to a risk-scoring system and follow-up. The two groups were compared analysing the following primary endpoints: 30-day mortality, stroke, stroke/death and acute myocardial infarction (AMI); GA patients’ survival rate and freedom from neurological events at 5 years. The 30-day secondary endpoints included carotid shunting, redo surgical, need for general anaesthesia with preserved consciousness (GAPC) conversion and length of hospital stay. Results We identified 620 patients with ACS, of them 144 (23.2%) belonged to the GA and 476 (76.8%) belonged to the GB. No statistical difference between the two groups was found regarding the primary and secondary endpoints. One hundred nineteen of 144 GA patients (82.6%) underwent the follow-up; the median follow-up was 78.3 months. The GA patients’ 5-year survival rate was 62%, while freedom from cerebral events was 94.9%. Analysis regarding GA patients’ 5-year survival rate revealed a significantly lower percentage among the patients with a severe risk score compared with those with a moderate risk score (respectively, 29.5% vs 67.7%; p = .005). The multivariate analysis showed that chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were independently associated with lower survival. Conclusions The 30-day outcomes of CEA in octogenarians are comparable to those in younger patients. Comprehensive life expectancy and preoperative score, rather than age alone, should be taken into account before performing CEA on octogenarian patients, considering the short- and long-term efficacy in stroke prevention.

Octogenarian Patients with Colon Cancer – Postoperative Morbidity and Mortality are the Major Challenges

2021 ◽  
Author(s):  
Øystein Høydahl ◽  
Tom-Harald Edna ◽  
Athanasios Xanthoulis ◽  
Stian Lydersen ◽  
Birger Henning Endreseth
Keyword(s):  
Colon Cancer ◽  
Survival Rate ◽  
Emergency Surgery ◽  
Relative Survival ◽  
Curative Intent ◽  
Term Survival ◽  
Younger Patients ◽  
Long Term Survival ◽  
Over Time

Abstract Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 100-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.Results Among 239 octogenarian patients treated with major resections with curative intent, the 100-day mortality was 10.1%. Among 215 patients that survived the first 100 days, the five-year relative survival rate was 99.7%. The 100-day mortality of octogenarian patients was significantly shorter than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 100-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 100‑day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 100-day mortality was high, but after surviving 100 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 100-day mortality risk.

scholarly journals Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19

2021 ◽  
Author(s):  
Neima Briggs ◽  
Michael V Gormally ◽  
Fangyong Li ◽  
Sabrina L Browning ◽  
Miriam M Treggiari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Question ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Primary Endpoints ◽  
Before And After ◽  
Secondary Endpoints ◽  
Design And Methods ◽  
Hospital Days

Background: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. Research Question: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? Study Design and Methods: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. Results: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P=0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P=0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P=0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P=0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. Interpretation: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.

scholarly journals Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study (Preprint)

2020 ◽  
Author(s):  
Sung-Yeon Cho ◽  
Sung-Soo Park ◽  
Min-Kyu Song ◽  
Young Yi Bae ◽  
Dong-Gun Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
High Risk ◽  
Hospital Stay ◽  
Risk Score ◽  
Validation Cohort ◽  
Length Of Hospital Stay ◽  
Risk Groups ◽  
Prognosis Score ◽  
Very High

BACKGROUND As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count &lt;1000/mm<sup>3</sup>. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (<i>P</i>&lt;.001). The length of hospital stay and disease severity were directly associated with overall survival (<i>P</i>&lt;.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.

scholarly journals Th1/Th17 cytokine profiles are associated with disease severity and exacerbation frequency in COPD patients

2020 ◽  
Author(s):  
Yan Yu ◽  
Lili Zhao ◽  
Yu Xie ◽  
Yu Xu ◽  
Weike Jiao ◽  
...  
Keyword(s):  
Clustering Algorithm ◽  
Clinical Manifestations ◽  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Luminex Assay ◽  
Cytokine Profiles ◽  
Th Cell ◽  
Th17 Cytokine

Abstract Background T helper (Th) cell cytokine imbalances have been associated with the pathophysiology of chronic obstructive pulmonary disease (COPD), including the Th1/Th2 and Th17/Treg paradigms. Clarifying cytokine profiles during COPD acute exacerbation (AE) and their relationships with clinical manifestations would help in understanding the pathogenesis of disease and improve clinical management.Methods Patients admitted to the hospital with AEs of COPD from January 2017 to August 2017 were included in this study, and follow-up was conducted after discharge (every 30 days, for a total of 120 days). Sputum samples of patients at different time points (including at admission, discharge, and follow-up) were collected, and sputum cytokine profiling (12 cytokines in total) was performed using a Luminex assay. Clinical data of patients were collected by a unified electronic medical record form.Results A total of 87 patients with COPD were enrolled, aged 72 ± 8.5 years, among whom 1, 12, 32, and 42 cases exhibited GOLD stage I, II, III, and IV, respectively. According to the cytokine profiles at admission, patients were divided into three clusters by a k -means clustering algorithm, namely, Th1 high Th17 high (n=26), Th1 low Th17 low (n=56), and Th1 high Th17 low (n=5), which revealed distinct clinical characteristics. Patients with Th1 high Th17 low profile had a significantly longer length of non-invasive ventilation time and length of hospital stay than patients with Th1 high Th17 high profile (7 vs. 0 days, 22 vs. 11 days, respectively, p < 0.05), and had the highest AE frequency. Sputum levels of Th17 cytokines (IL-17A, IL-22, and IL-23) during AE were negatively correlated with AE frequency in the last 12 months ( r = -0.258, -0.289 and -0.216, respectively, p < 0.05). Moreover, decreased sputum IL-17A levels were independently associated with increased AE frequency, whith an OR (95% CI) of 0.975 (0.958 - 0.993) and a p = 0.006.Conclusion Th1/Th17 imbalance during AE is associated with the severity of COPD. Decreased Th17 cytokine expression is correlated with increased AE frequency. The Th1/Th17 balance may be a specific target for the therapeutic manipulation of COPD.Trial registration: ClinicalTrials.gov ID: NCT03236480.

Clinical Features and Outcomes of Elderly Patients with Acute Promyelocytic Leukemia (APL) - the Japan Adult Leukemia Study Group APL97 Study.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1077-1077 ◽  
Author(s):  
Takaaki Ono ◽  
Akihiro Takeshita ◽  
Yuji Kishimoto ◽  
Hitoshi Kiyoi ◽  
Masaya Okada ◽  
...  
Keyword(s):  
Survival Rate ◽  
Elderly Patients ◽  
Clinical Features ◽  
Induction Therapy ◽  
Leukocyte Count ◽  
Elderly Group ◽  
Study Group ◽  
Consolidation Chemotherapy ◽  
Younger Patients

Abstract Abstract 1077 (Background) Studies focused on elderly APL are limited. The European APL study group reported in their APL 93 trial that lower survival rate in elderly APL was mainly due to an increase of early deaths and toxicity of chemotherapy (Ades et al, 2005). On the other hand, PETHEMA group reported in their LPA96 and 99 studies that ATRA combined with anthracycline monochemotherapy resulted in low toxicity and high compliance, and that survival rate is similar to younger patients (Miguel A et al, 2004). We analyzed clinical features and outcomes of elderly APL patients with APL who were treated with ATRA and intensive chemotherapy and compared with those of younger patients in long term follow-up of the JALSG-APL97 Study. (Methods) Patients with newly diagnosed APL were continuously registered from May 1997 to June 2002, and induction therapy was composed of ATRA and chemotherapy including idarubicin and cytarabine. The dose and duration of chemotherapy were based on initial leukocyte count. After completion of 3 courses of consolidation chemotherapy, patients negative for the PML-RARA transcript were randomly allocated either to receive 6 courses of intensified maintenance chemotherapy or to observation. Elderly patients were treated with the same schedule to younger patients (Asou et al, 2007). Clinical features as well as relapse rate (RR), overall survival (OS) and disease-free survival (DFS) were assessed in elderly group with aged 60 or more in comparison with younger group. Clinical outcomes were updated on January, 2009 and the median follow up period is 7.3 years. (Results) Of 302 patients registered in this study, 283 patients were assessable. The median age was 48 years (range, 15–70 years), with 237 patients in younger group (median age, 44 years) and 46 patients in elder group (median age, 63 years). Significantly lower platelet count (less than 10 × 109/L), higher incidence of ECOG performance status 3 to 4, lower albumin level (< 3.5g/dl) were observed in elderly group compared to younger group (P = 0.04, P = 0.02 and P < 0.001, respectively), while clinical characteristics including gender, initial leukocyte count, APL cells in peripheral blood, DIC score, frequency of variant type (M3v), expression of CD-phenotype, past history of chemotherapy and/or radiotherapy and number of infectious complications at diagnosis, did not differ between two groups. The CR rates and early mortality during induction therapy including to hemorrhagic complications were similar between two groups (89% vs. 96%, P = 0.06; 11% vs. 4%, P = 0.08), whereas induction death due to differentiation syndrome in elderly group is higher compared with younger group (4% vs. 0%, P = 0.03). The cumulative incidence of non relapse mortality (NRM) during the third consolidation chemotherapy was significantly higher in elderly group (9% vs. 1%., P = 0.04). All of the mortality occurred during consolidation therapy was associated with infection. Although OS was lower in elderly groups at 10 year compared with younger group (65% vs. 87%, P < 0.001), DFS and RR were similar between two groups (65% vs. 67%, P = 0.70; 13% vs. 26%, P = 0.15, respectively). (Conclusion) The present study demonstrated that efficacy of ATRA combined with chemotherapy in elderly APL was similar to younger APL. Nevertheless, lower OS at 10 year in elderly APL was observed in this study. One of the reasons was an increase of NRM, especially induction death due to differentiation syndrome and infection death during consolidation chemotherapy. Thus, reduction of intensity of post remission chemotherapy should be considered in elderly patients. Non-myelosuppressive agents such as arsenic trioxide and/or tamibarotene should be incorporated into the post remission therapy for elderly patients with APL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals P1762 Natural history and outcome of adults with bicuspid aortic valve: a middle-aged french cohort of 541 patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Bohbot ◽  
C Cheng ◽  
F Fay ◽  
F Elmkies ◽  
A L Gugeinheim ◽  
...  
Keyword(s):  
Survival Rate ◽  
Aortic Valve ◽  
Natural History ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Large Population ◽  
Relative Survival ◽  
Surgical Indication ◽  
Middle Aged

Abstract Funding Acknowledgements none Background No data are available regarding the natural history and outcomes of middle-aged European patients with bicuspid aortic valve(BAV), as the only 2 large studies were conducted on the other side of the Atlantic. Purpose To determine the frequency of cardiovascular events and to assess the survival relative to that of the general population(GP) in a large population of adults diagnosed with BAV according to the presence or the absence of a surgical indication at baseline. Methods Between 2005 and 2017, 350 patients without surgical indication (mean age 53, 71% men) and 191 patients with surgical indication (mean age 59, 71% men) at baseline were included. Median follow-up was 80 months. Results In the medical group, 34 deaths(9.7%) were recorded(10 cardiovascular). The 10-years survival rate was 88 ± 2% with a relative survival compared to the age-and-sex matched population of 98.8%. Nine patients(2.6%) were diagnosed with infective endocarditis (IE) and no aortic dissection occurred. Aortic valve and/or ascending aorta surgery was performed in 102 patients(29%) during follow-up. In the surgical group, 12 deaths(6.3%) were recorded(5 cardiovascular). The 10-years survival rate was 90 ± 3% with a relative survival compared to the matched population of 99.2%. Five patients(2.6%) were diagnosed with IE and no aortic dissection occurred. Conclusion Middle-aged adults with BAV have a high likelihood of surgery but a survival comparable to the GP. The rate of IE is low and no aortic dissection occurred in our study. Abstract P1762 Figure. a) survival curves B) surgery incidence

scholarly journals Systematic review: lack of evidence for the success of revision arthroplasty outcome in younger patients

2017 ◽  
Vol 28 (2) ◽  
pp. 109-114 ◽  
Author(s):  
Marloes W.J.L. Schmitz ◽  
Carla Timmer ◽  
Gerjon Hannink ◽  
Berend W. Schreurs
Keyword(s):  
Survival Rate ◽  
Revision Arthroplasty ◽  
Cochrane Library ◽  
Younger Patients ◽  
Revision Thas ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Subsequent Revision ◽  
The Cochrane Library

Introduction: Total hip arthroplasties (THAs) in younger patients are becoming increasingly popular. However, the outcome of subsequent revisions in younger patients is not well known and, therefore, their success (subsequent revision prosthesis survival) might be overestimated. We investigated available data on the outcome of primary- and subsequent revision THAs performed in the same cohort of patients who underwent primary THA under the age of 50. Methods: Medline, Embase and the Cochrane Library (CENTRAL) were searched up until April 13, 2016 for studies that reported both the survival of primary and subsequent revisions THA of single cohorts of patients younger than 50. Eligible articles had to include Kaplan Meier analysis or competing risk analysis for survival of the primary THA at a mean follow-up of 10 years, as well as for the subsequent revision THA within the same cohort. Results: We found 4,799 unique records; 43 of which were potentially eligible. Only 1 paper met our inclusion criteria. It reported on the survival of 69 primary prostheses at a mean of more than 10 years follow-up and 13 subsequent revisions. Conclusions: There is a clear lack of evidence about the outcomes of the revision arthroplasty in younger patients. Only 1 study reported the survival-rate of subsequent revision arthroplasty with the minimum 10-year survival rate of the original THA cohort. In the future, this serious lack of knowledge could result in a large number of patients with no further reconstructive options after failed THA, and a large medical burden for society.

scholarly journals Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254453
Author(s):  
Neima Briggs ◽  
Michael V. Gormally ◽  
Fangyong Li ◽  
Sabrina L. Browning ◽  
Miriam M. Treggiari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Question ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Primary Endpoints ◽  
Before And After ◽  
Secondary Endpoints ◽  
Design And Methods ◽  
Hospital Days

Background Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. Research question What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? Study design and methods We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. Results Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28–0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. Interpretation Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.

Papillary Carcinomas of the Gallbladder: Analysis of Noninvasive and Invasive Types

2005 ◽  
Vol 129 (7) ◽  
pp. 905-909 ◽  
Author(s):  
Jorge Albores-Saavedra ◽  
Matthew Tuck ◽  
Bernadette K. McLaren ◽  
Kelley S. Carrick ◽  
Donald Earl Henson
Keyword(s):  
Survival Rate ◽  
Open Cholecystectomy ◽  
Relative Survival ◽  
Distant Metastases ◽  
Gallbladder Wall ◽  
Cell Phenotype ◽  
Relative Survival Rate ◽  
Degree Of Differentiation ◽  
Hematoxylin Eosin

Abstract Context.—Although papillary carcinomas have been recognized as distinct morphologic variants of gallbladder neoplasms, they have been lumped together in a single group despite the recognition of noninvasive and invasive types. As a result, the biologic behavior of each type remains undescribed. Objective.—To compare the biologic behavior of noninvasive and invasive papillary carcinomas of the gallbladder. Design.—The clinical and morphologic features of 16 noninvasive papillary carcinomas (&gt;1 cm) of the gallbladder were analyzed, and their clinical behavior was compared with that of 370 invasive papillary carcinomas recorded in the Survey Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1973 through 2001. The biologic behavior of invasive papillary carcinomas was compared with that of invasive nonpapillary carcinomas of the gallbladder recorded in SEER. Hematoxylin-eosin–stained sections were available for review in the 16 noninvasive papillary carcinomas. The number of slides examined per case varied from 3 to 16, with an average of 7. Results.—The 16 patients with noninvasive papillary carcinomas included 11 women and 5 men, aged 34 to 83 years (mean age, 61 years). Thirteen patients had cholelithiasis. Laparoscopic cholecystectomy was performed on 12 patients and open cholecystectomy on 4. The tumors measured from 1.3 to 8.6 cm and were well to moderately differentiated. Fourteen noninvasive papillary carcinomas showed biliary phenotype, and 2 showed intestinal phenotype. Follow-up was obtained in 11 patients; 6 were asymptomatic 5 to 11 years after surgery, 2 were symptom free 9 months to 4 years following cholecystectomy, and 3 died of unrelated causes 2 to 3 years after surgery. Three hundred seventy cases of invasive papillary carcinomas were recorded in SEER. The 10-year relative survival rate for 225 patients with invasive papillary carcinomas confined to the gallbladder wall was 52%, while the 10-year relative survival rate for 83 patients with papillary carcinomas that had spread to the lymph nodes was less than 10%. Of the remaining 62 invasive papillary carcinomas, 58 had distant metastases and 4 were not staged. The 10-year relative survival rate for invasive nonpapillary carcinomas confined to the gallbladder wall was 30%. Conclusion.—Noninvasive papillary carcinomas of the gallbladder—regardless of size, cell phenotype, and degree of differentiation—do not metastasize, and a simple cholecystectomy appears to be a curative procedure. In contrast, invasive papillary carcinomas do metastasize and are associated with a poor prognosis (10-year relative survival rate for tumors confined to the gallbladder wall was 52%, while the 10-year relative survival rate for tumors with lymph node metastasis was &lt;10%). The separation of papillary carcinomas into noninvasive and invasive types is clinically relevant and therefore fully justified.

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