Clinic Study On The Surgical Treatment Of Primary Gallbladder Carcinoma

Because there is no special symptom and physical signs of primary gallbladder carcinoma, It is difficult to diagnose in early stage. Most of the patients of primary gallbladder carcinoma had been in middle or late stage when they came to the hospital. So the resection rate is low and the prognosis is dismal. It is reported that the 5 years survival rate of gallbladder carcinoma is less than 5%. The purpose of this study is to summarize the experiences in the diagnosis and treatment of primary gallbladder carcinoma in order to improve its prognosis.Materials and MethodsThe clinical records of 60 cases of gallbladder carcinoma in Sir Run Run Shaw Hospital from 1994-2000 were retrospectively reviewed, including clinical manifestation, laboratory examination, operative procedure, pathological diagnose, morbidity and mortality, and follow up result. Diagnosis was confirmed by pathology in all cases. Survival analysis was performed by Kaplan-Meier method and the significance was assessed by the Log-Rank test. All statistical analysis was carried out on SPSS 10.0 version for Windows.ResultThere were 25 males and 35 females patients, with M:F=1:1.4, the age ranged from 31 to 82 years old with a mean of 62.6. Right upper quadrant pain, jaundice and abdominal mass were their major clinical manifestations. There were 31 cases (51.7%) definitely diagnosed by preoperative ultrasonorgrapy(21/57) and CT(15/27),11cases(18.3%) were diagnosed by laparotomy and 18 cases(30%) were diagnosed by postoperative pathological examinations. 52 cases underwent surgical resection with a rate of 86.7%, of them 31 cases (52%) award curative resection. The type of operation are 11 cases(18.3%) of laparoscopical cholecystectomy(LC), 13 (21.7%) cases of open cholecystectomy(OC), 16 cases (26.7%) of standard radical cholecystectomy, 12 cases (20%) of extended radical cholecystectomy, 6 cases ( 10%) of palliative drainage and 2 cases( 3.3%) of puncture biopsy. Pathological diagnosis are 56 cases(93.3%) of adenocarcinoma, 3(5.0%) cases of adeno-squamous carcinoma and 1 (1.7%) case of neuro-endocrine tumor. Pathological differentiation: 10 cases (16.7%) of well differentiation , 17 cases (28.3%) of middle differentiation, 12 cases ( 20.0% ) of poor differentiation and 21 cases (35.0%) of unknow. Nevin stage: 7 (11.7%) cases of Nevin I stage, 2 cases (3.3%) of Nevin II stage, 13 cases (21.7%) of Nevin III stage and 37 cases (61.7%) of Nevin V stage. 59 cases werefollow-up with a follow-up rate of 98.3%. The statistical analysis indicated that the survival rate of Nevin V is prominently lower than Nevin I >, II and III. RO resection and extended radical resection can prolong the survival of Nevin V stage cases.Conclusionthe development of radiological technique and the wide use of laparoscopical cholecystectomy, maybe helpful to early diagnosis of. But the patients discovered after LC have a higher possibility of incision implant. In clinic, most cases are diagnosis at middle or late stage. For the patients with local advanced disease, extended resection (included HPD) maybe helpful to prolong the survival time.