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El cáncer de la vesícula biliar es una enfermedad rara, con una incidencia mundial de 2 casos por cada 100 000 individuos con un pronóstico desfavorable. Con el aumento de colecistectomías por causas benignas, se ha incrementado la detección incidental de neoplasias vesiculares en las piezas quirúrgicas, siendo este el método diagnóstico más frecuente, generando retrasos en el manejo y requiriendo reintervenciones extensas. Debido a lo anterior, se resalta la importancia de un diagnóstico temprano preoperatorio, con el objetivo de ofrecer un tratamiento quirúrgico potencialmente curativo. Se presenta el caso de un paciente masculino de 72 años con un cuadro intermitente de dolor abdominal y pérdida de peso de un año de evolución, el cual fue diagnosticado con cáncer vesicular en etapa temprana y sometido a una colecistectomía laparoscópica extendida con linfadenectomía y hepatectomía parcial con una evolución a 6 meses sin complicaciones y bajo un protocolo de vigilancia periódica.
Gallbladder cancer is a rare disease, accounting a global incidence of 2 cases per 100 000 individuals with an unfavorable prognosis. The rise in cholecystectomies for benign causes has increased an incidental detection of vesicular neoplasms in the surgical specimens, being the main diagnostic method, therefore it generated delay in the management, requiring extensive re-interventions. It is important to improve early preoperative diagnosis, with the aim of offering a potentially curative surgical treatment. We present a case of a 72-year-old male with intermittent abdominal pain and weight loss of one year of evolution, who was diagnosed with early stage gallbladder cancer and underwent an extended laparoscopic cholecystectomy with lymphadenectomy and partial hepatectomy with a 6 months evolution without complications and under a periodic surveillance protocol.
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Background: The minimally invasive surgery (MIS) in GBC is being increasingly performed with superior short term results and non-inferior oncological outcomes. Most of the studies on minimally invasive radical cholecystectomy (MIRC) included patients with GBC limited to the gall bladder. Bile duct or adjacent viscera has been resected only in a very few studies. One of the reasons perhaps for not imbibing MIS in advanced GBC is the innate complexity of resection of the involved adjacent organs and need performing a bilioenteric anastomosis. Aim of this study is to assess safety, feasibility and short-term outcomes of locally advanced GBC patients who underwent MIRC with adjacent bile duct or viscera resection. Methods: Retrospective analysis of prospectively maintained data of 11 patients who underwent MIRC with adjacent viscera resection for suspected case of GBC in a single surgical unit between January 2017 to December 2019 at Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, a tertiary referral teaching institute. Results: During the study period 11 patients underwent adjacent viscera resection along with MIRC.Ten patients had Common bile duct (CBD) excision (4 choledochal cyst and 6 direct tumor infiltration), four patients had gastroduodenal resection (3 sleeve duodenectomy and 1 distal gastrectomy with proximal duodenectomy) and three patients had colonic resection (2 sleeve resection and 1 segmental resection). Seven patients had single organ resection (3 CBD and 4 CDC), 2 of them had double organ (CBD & duodenum, duodenum & colon) and 2 patients had triple organ resection (CBD, duodenum and colon). Conclusion: The minimally invasive approach inGBC patients who need extrahepatic adjacent viscera resection was found to be feasible and safe with favourable perioperative and oncological outcomes.Further studies are needed from high-volume centres engaged in minimally invasive hepatobiliary surgery.
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Gallbladder cancer (GBC) is the most common malignant tumor of the biliary tract, with a high degree of malignancy and poor prognosis. R0 resection is the basic principle of surgical treatment of GBC. However, disputes still exist over the extent of liver resection, extrahepatic bile duct resection, range of lymphadenectomy, surgical treatment of GBC diagnosed during or after surgery, and the application of laparoscopy in GBC. This paper reviews the progress in surgical treatment of GBC and discusses the disputes over surgical treatment in order to provide reference for clinical research and treatment of GBC in clinical work.
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Gallbladder cancer is a biliary malignant disease with difficulty in early diagnosis,high malignancy and poor prognosis.Radical resection is the most effective approach to improve the prognosis of patients.With the update of minimally invasive devices and the accumulation of surgeon experience,laparoscopic surgery has achieved satisfactory results in the treatment of malignant tumors of the digestive tract,but there is still controversy in its application in gallbladder cancer treatment,mainly due to lack of reliable evidence for improved survival outcomes.The current studies indicated that laparoscopic surgery could benefit some patients with early gallbladder cancer in perioperative period and survival.For advanced gallbladder cancer,although there is still no consensus on the resection extent,laparoscopic staging can prevent patients from unnecessary expanded resection.The minimally invasive process of radical cholecystectomy needs to be promoted through a high-quality diagnosis and treatment process.Only in this way can there be practical clinical evidence to guide the best clinical practice.
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Objective@#To investigate the rationale for appropriate diagnostic methods and treatment protocols for unexpected gallbladder carcinoma(UGC).@*Methods@#The clinical and pathological data of 45 patients with UGC admitted at Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine,from January 2008 to December 2017 were retrospectively collected and analyzed.There were 11 males(28.9%) and 34 females(71.1%),aged 68 years(range:27 to 68 years).And there were 20 cases who aged above 70 years. Twenty-four cases were diagnosed preoperatively as cholecystolithiasis plus chronic cholecystitis.Ten cases were diagnosed preoperatively as cholecystolithiasis plus actue cholecystitis.Six cases were diagnosed preoperatively as cholecystolithiasis plus choledocholith.Six cases were admitted because of gallbladder polyp and 1 case was admitted because of gallbladder adenomyomatosis.@*Results@#Thirty-four patients with UGC received radical surgery.Among them,11 patients experienced postoperative complication and no posterative mortality occoured during hospital stay.Thirteen patients were diagnosed with T1b UGC, the harvested lymph node of Nx, N0, N1 and N2 was 2, 9, 1 and 1, respectively.In addition, 2 cases were identified to have local-regional tumor recurrence during our rescue radical surgery.The median overall survival time of the patients who did not receive radical surgery was 7 months(range:2-56 months).Nevertheless,the median overall survival time for patients diagnosed with T1, T2 and T3 tumors who received radical surgery, was 41 months(range: 19-82 months), 33.5 months(range: 31-36 months) and 17 months(range: 7-46 months), respectively.@*Conclusions@#For patients with UGC, rescue radical surgery can achieve a better survival time.Furhtermore, our experience proved that rescue radical surgery for UGC is safe and feasible.Therefore,rescue radical surgery should be performed in patients with diagnose with UGC especially those T1b patients.
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Objective To compare the efficiency of laparoscopic cholecystectomy (LC) and radical cholecystectomy (RC) in the patients with early gallbladder carcinoma. Methods From January 2001 to December 2008, 63 patients who had underwent LC(28 cases) or RC(35 cases) were analyzed retrospectively. The survival and recurrence rate after operation and complication were compared. Results After treatment, the complication in the LC group was less than that in the RC group (7. 1% vs. 48. 6%, χ2 = 12. 675 ,P ＜0.01). In the RC group,the 1,3,5 year overall cumulative survival rate of Nevein phase Ⅰ were all 100%, and 76. 2%, 42. 9%, and 23. 8% respectively in the phase Ⅱ. The overall cumulative survival rate of LC cases were 81.8%, 54. 5%,27.3% in phase Ⅰ and 17.6% ,5.9% ,0.0% in phase Ⅱ, respectively. The survival curves between the two groups were significantly diffierent(phase Ⅰ χ2 =20.74,P＜0.001; phase Ⅱ χ2 = 11.35,P＜0.001) and the survival rate in the RC group was higher than that in the LC group. The 1,3,5 year cumulative recurrence rates in the RC were 20.0%, 48. 6%, 68. 6%, respectively, which is significantly lower than those in the LC group (60.7%,85.7% and92.9%, respectively)(χ2 =10.30,P=0.0013).Conclusions RC is one of the first choices for early gallbladder carcinoma treatment, and will decrease the recurrence rate and improve the long-term life quality.
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Objective: To report our experience in the management of incidentally detected carcinoma gall bladder and establishment of a treatment protocol. Method: Retrospective review of 7 patients with incidentally detected carcinoma gall bladder during and after laparoscopic cholecystectomy for presumed benign disease. Clinical and histopathological data, treatment and long term outcome of all seven patients were reviewed. Exploratory laparotomy and radical surgery with curative intent consisting of liver resection, lymphadenectomy of the pedicle and excision of the port site were performed in all patients. Results: Liver resection including the segments IVB and V was done in 5 patients and in 2 patients resection of a wedge of hepatic parenchyma of more than 2 cm thickness including the gall bladder bed was carried out. Five patients underwent common bile duct excision with hepaticojejunostomy. Postoperatively, 2 patients developed fever and 1 patient had minimal altered blood in the nasogastric tube aspirate. These were successfully managed conservatively. All 7 patients had disease of pathological stage II and beyond. All patients received adjuvant chemotherapy. One patient died after 2 months of cholangitis and sepsis. One patient succumbed to metastatic disease after 12 months. The remaining patients are disease free on follow up. Conclusion: Re-exploration and aggressive resection with adjuvant chemotherapy for incidental carcinoma of the gallbladder is safe and offers hope for long term survival.
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PURPOSE: The prognosis of advanced gallbladder cancer remains unfortunate. Yet, the prognostic factors and the efficacy of extrahepatic bile duct resection remain unclear. The adequacy for extrahepatic bile duct resection for T2 gallbladder cancer, according to the characteristics of either the clinicopathological factors or the prognostic factors, was evaluated. METHODS: One hundred and one patients with gallbladder cancer underwent surgical resection at Yeungnam University Medical Center (YUMC) between January 2001 and July 2008. A retrospective analysis was conducted on 26 patients with pathologic stage T2. RESULTS: 7 of the 26 patients with T2 disease (26.9%) had lymph node metastasis. Of the 7 patients with lymph node metastasis, 3 patients underwent radical cholecystectomy (RC), and 4 patients underwent radical cholecystectomy combined with extrahepatic bile duct resection (RC+BDR). The 1-year and 3-year survival rate of patients that underwent RC was 66.7% and 0% and patients that underwent RC+BDR was 50.0% and 0%, respectively (P=0.433). Even with microscopic vascular invasion or perineural invasion, RC+BDR did not provide any survival advantage compared with RC in T2 gallbladder cancer. Prognostic factors for patients with T2 gallbladder cancer was total bilirubin level, lymph node metastasis, differentiation of tumor, microscopic vascular invasion and perineural invasion. CONCLUSION: For patients with T2 gallbladder cancer, RC is recommended, even with the presence of lymph node metastasis, microvascular invasion or perineural invasion. Resection of the extrahepatic bile duct is indicated for patients with T2 gallbladder cancer with involvement of the cystic duct or invasion of the hepatoduodenal ligament.
Subject(s)
Humans , Academic Medical Centers , Bile Ducts, Extrahepatic , Bilirubin , Cholecystectomy , Cystic Duct , Gallbladder , Gallbladder Neoplasms , Imidazoles , Ligaments , Lymph Nodes , Neoplasm Metastasis , Nitro Compounds , Prognosis , Retrospective Studies , Survival RateABSTRACT
PURPOSE: The aim of the present study was to determine proper treatment strategies to improve the outcome of patients with gallbladder cancer by an analysis of multiple factors affecting tumor recurrence and patient survival. METHODS: Between January 1991 and April 2006, surgery with curative intent was performed on 120 patients with gallbladder cancer. Of 120 cases, 35 patients had findings that precluded any further intervention, and the remaining 85 patients underwent curative resections that included a simple cholecystectomy in 43 cases, a radical cholecystectomy in 32 cases and an extended cholecystectomy in 10 cases. Clinicopathogical data was analyzed. RESULTS: The presence of jaundice at presentation, gross morphology of the tumor, tumor cell differentiation, presence of a lymph node metastasis, lymphatic invasion and direct invasion to other contagious organ(s) and achievement of a tumor-free resection margin were associated with survival. For stage I gallbladder cancer, in only T2 lesions, patients that undergone a simple cholecystectomy had double the rate of recurrence as compared to patients that undergone a radical cholecystectomy (12.5% versus 26.1%; p = .119). For stage II gallbladder cancer, survival and disease-free survival for patients that undergone a radical cholecystectomy were improved as compared to patients that undergone a simple cholecystectomy; survival and disease-free survival was poor for patients that had undergone an extended cholecystectomy, especially in patients that had bile duct invasion (4/5; 80%). For stage III/IV gallbladder cancer, all patients (n = 6) underwent an extended cholecystectomy and half of the patients survived longer than one year. CONCLUSION: Radical cholecystectomy could be a standard procedure for gallbladder cancer in addition to just stage II cancer. An aggressive approach including resecting contagious organ(s) in locally advanced gallbladder cancer could provide a survival benefit without an increase in complications.