ABSTRACT
Purpose: The surgical management of gallbladder cancer discovered after cholecystectomy is controversial. There is no consensus as to the indication for reoperation or radical resection. The aim of this study was to review the results of reoperation and results of extended resection of theses patients
Methods: fifty three patients were referred to our center with pathological diagnosis of cancer after cholecystectomy. Ten other cases were added with a clinical diagnosis of gall bladder cancer and had their primary treatment in our side. Of the total 63 cases 17 [27%] cases underwent extended resection while the others had residual disease far extensive for resection. Extended resection included partial resection of segment IV and V together with nodal dissection of the hepatoduodenal ligament. Two cases had extended right hepatectomy
Results: The mean survival period for cases with extended resection was 28.7 months while for simple cholecystectomy it was 11.2 months. Two years and 5-years survival rates were 52.9% and 11.7% respectively for extended resection patients while, for cases treated by simple cholecystectomy alone they were 21.7% and 6.2% respectively. Extended resection had better results for T2 cases than T3 cases and cases with nodal involvement had poor results in comparison to node negative cases
Conclusion: Simple cholecystectomy alone is not enough for gallbladder cancer with deep invasion more than T1. Second surgery should be restricted for cases without nodal involvement and for T2 more than T3 cases provided there is no other sign of dissemination
ABSTRACT
Objectives: A prospective clinical trial to assess the functional lower urinary tract voiding outcomes after orthotopic ileal W-neobladder urinary diversion following cystectomy
Material and Methods: Between February 1999 and September 2002, a total of 19 male patients with median age of 49.5 [38-67] years, having bladder cancer, underwent radical cystoprostatectomy and lower urinary tract reconstruction by means of detubularized ileal W-neobladder [Hautmann technique] as an orthotopic diversion. We made a modification at the pouch urethra anastomosis region to create a neobladder neck with funneling to improve continence. The functional voiding outcome was determined by a detailed patient interview, urodynamic studies and radiological investigations
Results: Daytime continence was 53% in the immediate postoperative period and increased to 94% after 12 months. Nighttime dryness was 32% and improved to 74%. The median neobladder pouch capacity was 510 ml 6 months after surgery and the mean voiding volume to reservoir capacity ratio was 53%. This ratio increased to 99% after one year with rapid decrease in residual volume. Continence satisfaction was 32% in the immediate post operative period -increased to 74% after one year. The upper urinary tract function kept stable or improved in 17/19 [89.4%]. Dilatation of the pelvicalyceal and the ureter either unilateral or bilateral occurred in two patients. Six cases [31%] had early postoperative complications and did not required surgical intervention. Early post operative complications related to neobladder included [15.8%] urinary leakage and [21%] prolonged ileus. Late complications related to the neobladder was found in 8 cases [42%] included metabolic acidosis [40%], urinary retention [18%] and ureteric stricture in [10.5%]
Conclusion: Ileal W-neobladder produces good functional results and can be constructed with acceptable easily treatable complications