Relationship Between Pathological Staging Of Gallbladder Cancer And Selection Of Operation Mode

Objective: To analyze the relationship between pathological staging of gallbladder cancer and selection of operation mode, and provide reference for reasonable selection of operation mode based on pathological staging and further judging prognosis. Methods: Review, summarize and analyze the cases of 35 patients with gallbladder carcinoma in The First Affiliated Hospital of Wannan Medical College from January of 2011 to December of 2013. Verify all cases through the clinic or post-operation pathology, carry out follow-up visit, review them according to the domestic and foreign literature, and make analysis. Results: This group is composed of 35 patients, among which, there are 10 men patients and 25 women patients. The ratio of men and women is 1:2.5. The oldest patient is 84 years old, and the youngest one is 40 years old, so the average age is 55.4. There are 27 patients at the age of more than 50. In 35 cases: as cholecystic polypus was detected during the physical examination, 11 patients were diagnosed with gallbladder carcinoma in pathological examination after the cholecystectomy, accounting for 31.4%; 15 patients were with gall bladder and cholecystic polypus,accounting for 42.9%; six patients were with jaundice, accounting for 17.1%; 27 patients were with upper right abdominal pain, accounting for 77.1%; 4 patients caught fever, accounting 11.4%; 8 patients’ weight reduced, accounting for 22.9%. All patients went through B-mode ultrasonography, and 22 patients were diagnosed, and the diagnosis accordance rate was 62.86%(22/35); 19 patients went through CT before therapy, and 15 patients were diagnosed, and the diagnosis accordance rate was 78.95%(15/19); 6 patients went through ERCP before therapy, and 4 patients were diagnosed, and the diagnosis accordance rate was 66.67%(4/6). Before the therapy, 22 patients were confirmed with gallbladder carcinoma, and the pre-operation diagnosis rate was 62.86%(22/35). The comparison on the positive rates through imageological examination: CT examination of gallbladder carcinoma has remarkable difference from the diagnostic accuracy rate of B-mode ultrasonographybefore therapy(P ﹤ 0.05). Tumor marker checking: in the cases of tumor marker checking, there are 22 patients with positive CA19-9, 13 patients with positive CEA and 11 patients with positive CA125. As for two kinds and above of combined tumor markers, 12 patients were increased. In this group with 35 cases, 5 and 4 patients went through purecholecystectomy and radical cholecystectomy respectively(2 patients went through pure cholecystectomy in other hospital due to the calculus or polypus, and thepathological examination after the therapy presented gallbladder carcinoma, and then they came to our hospital for the radical operation); 7, 6, 5, and 2 patients went through extended radical operation, gallbladder excision and biliary enterostomy, gallbladder excision and external drainage, and pancreaticoduodenectomy(considerobstructive jaundice before therapy; adenocarcinoma perampullaire, the post-operation pathological result presented: high differentiation adenocarcinoma of the gallbladder, pancreas, common bile duct) respectively; 6 patients went through lump biopsy. All specimens were diagnosed through the pathological examination. Among them, there were 29 cases with adenocarcinoma(83%), 4 cases with mucinous adenocarcinoma, 1 case with squamous carcinoma, and 1 case with adenosquamous carcinoma. At present, the stage of the gallbladder carcinoma mostly adopts Nevin stage,American Joint Committee on Cancer(AJCC) and JSBS. Although the standard of these three stage methods is different, the definition for the infiltration degree(T) of the gallbladder carcinoma is basically the same. This research adopts TNM stage. In TNM stage, there were 2 cases in Period 0, 5 cases in Period I, 4 cases in period II, 16 cases in Period III, and 8 cases in Period IV. 2 patients in Period 0 went through pure cholecystectomy; 3 out of 5 patients in Period I went through pure cholecystectomy and the rest 2 patients went through radical cholecystectomy; 2 out of 4 patients in Period II were exerted with radical cholecystectomy and the rest two patients were exerted with extended radical operation; 5 out of 16 patients in Period III went through extended radical operation of gallbladder carcinoma, and the rest 11 patients went through palliative surgery and drainage; 2 out of 8 patients in Period III went through palliative surgery and drainage, and the rest 6 patients went through lump biopsy. 32 cases were followed up. The follow-up visit rate was 91.43%(32/35). 2 patients in Period 0 were not followed. 5 patients in Period I were followed, among which, 1 patient lasted the life for 1 year, 2 patients for 2 years and 3 years respectively. 3 patients in Period II were followed, among which, 1 patient lasted the life for 1 year, 2 patients for 2 years. 16 patients in Period III were followed, among which, 10 patients died in one year, and 3 patients survived for 1 year, and other 3 patients survived for 2 years. Patients in Period IV were followed, among which, 2 patients survived for 1 year and 6 patients died in a year. The gross survival rate for one year was 21.9%, and that for three years were6.25%(2/32). Conclusion: 1.The middle-aged and old people, especially the female, have high morbidity of gallbladder carcinoma.2.B-mode ultrasonography is a common method for detecting the gallbladder carcinoma. The rate of accurately diagnosing the gallbladder carcinoma is higher than that of B-mode ultrasonography.3. Tumor marker CA19-9 is sensitive to the gallbladder cancer, can be used as an important reference markers for early diagnosis.4.Most patients with the relatively early pathological TNM of the gallbladder carcinoma(e.g. Period 0, Period I, and Period II) select cholecystectomy, radical cholecystectomy or extended radical operation; the patients with late pathological TNM basically lose the chance of radical operation, but only can go through palliative operation or biopsy. 5.The prognosis status of all patients is positive, and they can survive for long time. The surgery for the patients with the advanced gallbladder carcinoma cannot achieve good effect. Both one-year and three-year postoperation survival rate are low.