Diagnosis And Treatment Of Unsuspected Gallbladder Carcinoma

Objective: To summarize the experience of diagnosis and treatment of unsuspected gallbladder carcinoma and reduce pre-operative false negative rate. Early diagnosis and surgical treatment would be made to increase the survival rate and life quality after operation.Methods: The clinical review of 23 unsuspected gallbladder carcinoma cases which were found through the operative and postoperative pathological diagnosis would be collected(offered by the Department of Hepato-Biliary Surgery of Qingdao Municipal Hospital(East) in Shandong Province, from October 2006 to July 2014). These cases were analysed with statistical ways on aspects of high risk factors, pathological diagnosis, surgical methods and follow-up results.Results: The group was consisted of 23 cases including 7 males and 16 females. 21 patients were followed up and the follow-up rate was 91.3%. All the patients were belonged to the high-risk population of the gallbladder cancer. The average age was 65±13 years. 13 cases were diagnosed as gallbladder stones; 2 cases were diagnosed as gall bladder polyps; 2 cases were diagnosed as gallstones with gall bladder polyps; 1 cholecystitis cases, 4 common bile duct stones and gallstones cases, 1 liver cyst with gallstones case were diagnosed. There was 1 emergency surgery case. Intra-operative frozen section pathological diagnosis had 15 cases, 8 cases were pathological diagnosis. According to the seventh edition of American Cancer Associations TNM staging, 4 cases were in T1 a while 10 cases were in T1 b, 7 cases were in T2 stage, 2 cases were in T3 stage, 0 cases were in T4 stage. After surgery, I stage surgery had 20 cases while II stage surgery had 3 cases. 14 patients underwent simple cholecystectomy. 9 patients underwent gallbladder cancer radical surgery. All T1 a patients underwent simple cholecystectomy. 7 cases in T1 b patients undertook simple routine cholecystectomy, 3 patients were undertook gallbladder radical surgery(cholecystectomy + liver ligament dissection + liver tissue depth> 3cm of wedge resection), while T2 patients were with a simple routine cholecystectomy, 6 cases were undertook gallbladder radical surgery, and All T3 patients underwent simple cholecystectomy. Pathological diagnosis of all patients were gallbladder adenocarcinoma among 9 cases. 8 cases were diagnosed as moderately differentiated adenocarcinoma; 4 cases were diagnosed as poorly differentiated adenocarcinoma; 2 cases were diagnosed as signet ring cell carcinoma. Among 21 patients, 19 patients were followed up for 0 to 54 months including one of T1 a and one of T1 b. 2 cases were lost during 54 months. The mean survival time was 31±14 months. Three patients of T1 a stage were still survival for 42 to 54 months after operation; The median survival time of nine patients of T1 b stage were 48 months and seven patients of T2 stage were 24 months. One patient of T3 stage lived for 4 months and died for multiple organ failure after operation, the other patient lived for 16 months and died for tumor recurrence and distant metastasis. We analyzed the cases in different index. In gender index, 3 female and 2 male patients died, chi-square tested p=0.599; in tumor stage, one patient of T1 b,two patients of T2 and two patients of T3 died, chi-square tested p=0.025; in the operation mode, 3 patients died with simple cholecystectomy and 2 patients died with radical surgery, chi-square tested p=0.375. The Kaplan-Meier method was used to analyze the differences in different indexes. The Chi-Square value of Logrank test were 0.100(p=0.751), 22.444( p<0.01) and 0.214( p=0.644) on the indexes of gender, tumor stage and operation mode.Conclusion: The diagnosis of early gallbladder carcinoma is difficult so that perfect preoperative examination especially imaging examination is very important. Gallbladder cancer should be noted during the cholecystectomy, frozen section examination should be applied to the highly suspected patients. The prognosis and the cumulative survival rate of the patients were more obviously affected by tumor stage and least by gender difference and operation mode.