Analysis Of Diagnosis,Treatment And Prognosis For Unsuspected Gallbladder Carcinoma

Objective:To explore the experience of diagnosis and treatment of unsuspected gallbladder carcinoma,reduce pre-operative false negative rate of it,make early diagnosis and appropriate surgical treatment,improve life quality of patients with unsuspected gallbladder carcinoma.Methods:We reviewed 27 patients with unsuspected gallbladder carcinoma after postoperative offered by the Department of Fourth Hospital of Hebei Medical University from April 2010 to December 2018.It was analyzed for high risk factors,surgical methods,pathological diagnosis and follow-up of these cases.Results:All 27 cases were belonged to high-risk population of gallbladder cancer,of with,8 males and 19 females,the youngest 27 years and the oldest 82 years,average age 61±13 years,11 cases suffered from upper abdominal pain,2 cases with jaundice,1 case with chills and fever,5 cases diagnosed as cholecystolithiasis,11 cases diagnosed as gallbladder tumors(include gallbladder polys),5 cases diagnosed as gallbladder stones with tumors,1 case diagnosed as gallstone gangrenous cholecystitis,1 case diagnosed as cholecystolithiasis with choledocholithiasis,1 case diagnosed as hepatic hemangioma with gallbladder wall thickening,2 cases diagnosed as biliary dilatation,6 cases with preoperative elevated tumor markers(CA19-9 or CEA).Eight cases were in T1 a stage,6 cases were in T1 b stage,6 cases were in T2 a stage,4cases were in T2 b stage,3 cases were in T3 stage and 0 case was in T4 stage according to the Eighth Edition of American Gallbladder Carcinoma Associations TNM staging.All cases were underwent surgical treatment.Seventeen cases were underwent simple routine cholecystectomy,10 cases were underwent gallbladder cancer radical surgery(cholecystectomy + liver tissue depth 2-3cm of wedge resection+ liver ligament dissection).Seven cases in T1 a were underwent simple routine cholecystectomy,1 case was undertook gallbladder radical surgery,3 cases in T1 b were undertook simple routine cholecystectomy,3 cases in T1 b were undertook gallbladder radical surgery,4 cases in T2 a undertook simple routine cholecystectomy,2 cases in T2 a were undertook gallbladder radical surgery,1 case in T2 b was undertook simple routine cholecystectomy,3 cases in T2 b were undertook gallbladder radical surgery,2 cases in T3 were undertook simple routine cholecystectomy and 1 case in T3 was undertook gallbladder radical surgery.Pathological diagnosis of all cases was gallbladder adenocarcinoma,24 cases were diagnosed as adenocarcinoma and 3 cases were diagnosed as adenosquamous carcinoma.Twenty-five cases were followed up for 2 to 60 months,the mean survival time was 36±22 months.Two cases were missed,including 1 case in T1 b stage and 1 case in T2 b stage.1 case was lost at 60 months and anther case was lost at 38 months.The cases in T1 a stage were all survival for 3 to 60 months after operation.In 5 cases of T1 b stage,1 case died of cardiac failure at 51 months after operation,median survival time was 51 months.In 9 cases of T2 stage(T2a and T2b),1 case died of distant metastasis at 6 months after operation,1 case died of cerebrovascular accident at 55 months after operation,the median survival time was 36 months.Three cases of T3 stage died of multiple metastasis after operation.There were 3 cases death in females and 3 cases death in males,it was no statistical difference(P=0.344).Two cases with elevated tumor markers(CA19-9 or CEA)and 4 cases with normal were death,with no significant difference(P = 0.606).No death was found in T1 a stage,1 case of T1 b stage died,1 case of T2 a stage died,1 case of T2 b stage died and 3 cases of T3 stage died,there was significant difference(P=0.009).There were 4 cases died after simple cholecystectomy and 2 cases died after radical cholecystectomy,with no significant difference(P=0.545).There was significant difference for the cumulative survival rate of tumor stage(P< 0.01),but there were no significant difference for the cumulative survival rate of sex(P =0.378),tumor marker(CA19-9 or CEA)(P =0.393)and operation method(P=0.560).Conclusion: Unexpected gallbladder carcinoma is lack for specific clinical manifestations and its early diagnosis is difficult.It is very important to improve the laboratory examination and preoperative imaging.We should be on guard against the possibility of external gallbladder cancer in patients with high risk of cholecystectomy in clinical practice.