Incidence and Overall Survival of Biliary Tract Cancers in South Korea from 2006 to 2015: Using the National Health Information Database

BACKGROUND/AIMS: There have been no nationwide studies to investigate the trends in incidence and 5-year survival rates of intra- and extrahepatic bile duct cancers and gall-bladder cancer. Therefore, our study aimed to describe the incidence and 5-year survival rates of biliary tract cancers by subsites in South Korea. METHODS: A total of 86,134 patients with biliary tract cancers were selected from the National Health Information Database. Age-standardized incidence rates and annual percentage changes were calculated. Life-table methods and log-rank tests were used to determine the differences in survival rates. Cox-proportional hazard models were used to estimate the hazard ratio of the patients with biliary tract cancers. RESULTS: The incidence rate of intra-hepatic bile duct cancer decreased by 1.3% annually from 8.8 per 100,000 in 2006 to 7.8 per 100,000 in 2015. Extrahepatic bile duct cancer also showed a decreasing trend by 2.2% per year from 8.7 per 100,000 in 2006 to 6.7 per 100,000 in 2015. Gallbladder cancer showed the greatest decline, with an annual percentage change of 2.8% from 6.3 per 100,000 to 5.2 per 100,000 during the same period. The 5-year survival rates were 30.0% in gallbladder cancer, 27.8% in extrahepatic bile duct cancer, and 15.9% in intra-hepatic bile duct cancer. CONCLUSIONS: The overall incidence rates of intrahepatic and extrahepatic bile duct cancer and gallbladder cancer decreased from 2006 to 2015. Among biliary tract cancers, intrahepatic bile duct cancers exhibited the highest incidence rate and the worst survival rate.

Pilot study of the relationship between clinical classification of gallbladder cancer and prognosis: a retrospective multicenter clinical study / 中华外科杂志

Objectives@#To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.@*Methods@#The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ2 test, survival analysis was carried by Kaplan-Meier and Log-rank test.@*Results@#Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ2=288.60,P<0.01),N stage(χ2=68.10, P<0.01), vascular invasion(χ2=128.70, P<0.01)and neural invasion(χ2=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ2=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05).@*Conclusion@#With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

Frozen sections examination for diagnosis of unexpected gallbladder neoplasm during cholecystectomy in acute cholecystitis / 中华普通外科杂志

Objective To explore the clinical significance of intraoperative frozen sections for the diagnosis of unexpected gallbladder neoplasm during cholecystectomy for acute cholecystitis.Methods We retrospectively analyzed the clinical data of acute cholecystitis patients who underwent cholecystectomy at the First Affiliated Hospital of Zhengzhou University,from Dec 2012 to Dec 2017.Results In the 1 386 acute cholecystitis patients,19 patients were found to have concurrent gallbladder neoplasm.Surgeons accurately recognized 9 gallbladder neoplasms by general observation alone,including 2 T2 and 2 T3 gallbladder neoplasms,but missed 10 gallbladder neoplasms.At the same time,we found that 3 Tis and 1 T1a gallbladder neoplasms were missed by frozen sections from 10 gallbladder neoplasms diagnosed by definitive histopathological examination.The sensitivity of frozen sections diagnosis was 60％ and the specificity was 100％.Conclusions During cholecystectomy for acute cholecystitis,the accuracy of surgeons' diagnosis with general observation in unexpected gallbladder neoplasm is poor.The accuracy of frozen sections to diagnose advanced gallbladder neoplasm is high,so we advocate frozen sections of every cholecystectomy sample in acute cholecystitis patients.

Neoplasia papilar intracolecística: reporte de un caso y revisión de la evidencia existente / Intracholecystic papillary neoplasia: report of a case and review of existing evidence

La neoplasia papilar intracolecística (NPIC), es un tumor compuesto por células neoplásicas preinvasivas, que forman masas de hasta 1,0 cm, clínicamente detectables. El objetivo de este estudio fue reportar un caso de NPIC y revisar la evidencia existente. Se trata de un paciente sexo masculino, de 33 años de edad, asintomático, que en el curso de un examen de salud, se realiza una ecotomografía abdominal, en la que se verifica una lesión polipoide vesicular de 32 x 19 mm de diámetro. Se programa para colecistectomía electiva, la que se realizó por vía laparoscópica, cirugía que se pudo realizar sin inconvenientes. Una vez extirpado el espécimen, se fue a estudio histopatológico en el que tras un mapeo vesicular se concluye NPIC, colecistitis crónica inespecífica, colesterolosis y pólipos colesterínicos. El paciente ha evolucionado sin inconvenientes. Presentamos un caso de NPIC en un paciente joven, cuyo diagnóstico fue confirmado por anatomía patológica tras una colecistectomía electiva, descartándose la presencia de carcinoma invasivo y displasia de alto grado, por lo que el pronóstico es favorable.

Intracholecystic papillary neoplasm (ICPN) is a tumor composed of pre-invasive neoplastic cells, with up to 1.0 cm clinically detectable masses. The objective of this study was to report a case of NPIC and review the evidence in the literature. A 33-year-old asymptomatic male patient had an abdominal ultrasonography during a health examination, in which a vesicular polyp lesion of 32 x 19 mm in diameter was verified. Thepatient was subsequently scheduled for elective cholecystectomy, which was performed laparoscopically and the surgery was uneventful. Once removed, the specimen was studied histopathologically and after performing vesicular mapping, we determined an ICPN, chronic non-specific cholecystitis, cholesteroliasis and cholesteric polyps. The patient has evolved without reported problems. We present a case of ICPN in a young patient, whose diagnosis was confirmed by pathological anatomy after an elective cholecystectomy, ruling out the presence of invasive carcinoma and high-grade dysplasia, with a favorable prognosis.

The survival prediction model of advanced gallbladder cancer based on Bayesian network: a multi-institutional study / 中华外科杂志

Objective@#To investigate the clinical value of Bayesian network in predicting survival of patients with advanced gallbladder cancer(GBC)who underwent curative intent surgery.@*Methods@#The clinical data of patients with advanced GBC who underwent curative intent surgery in 9 institutions from January 2010 to December 2015 were analyzed retrospectively.A median survival time model based on a tree augmented naïve Bayes algorithm was established by Bayesia Lab software.The survival time, number of metastatic lymph nodes(NMLN), T stage, pathological grade, margin, jaundice, liver invasion, age, sex and tumor morphology were included in this model.Confusion matrix, the receiver operating characteristic curve and area under the curve were used to evaluate the accuracy of the model.A priori statistical analysis of these 10 variables and a posterior analysis(survival time as the target variable, the remaining factors as the attribute variables)was performed.The importance rankings of each variable was calculated with the polymorphic Birnbaum importance calculation based on the posterior analysis results.The survival probability forecast table was constructed based on the top 4 prognosis factors. The survival curve was drawn by the Kaplan-Meier method, and differences in survival curves were compared using the Log-rank test.@*Results@#A total of 316 patients were enrolled, including 109 males and 207 females.The ratio of male to female was 1.0∶1.9, the age was (62.0±10.8)years.There was 298 cases(94.3%) R0 resection and 18 cases(5.7%) R1 resection.T staging: 287 cases(90.8%) T3 and 29 cases(9.2%) T4.The median survival time(MST) was 23.77 months, and the 1, 3, 5-year survival rates were 67.4%, 40.8%, 32.0%, respectively.For the Bayesian model, the number of correctly predicted cases was 121(≤23.77 months) and 115(>23.77 months) respectively, leading to a 74.86% accuracy of this model.The prior probability of survival time was 0.503 2(≤23.77 months) and 0.496 8(>23.77 months), the importance ranking showed that NMLN(0.366 6), margin(0.350 1), T stage(0.319 2) and pathological grade(0.258 9) were the top 4 prognosis factors influencing the postoperative MST.These four factors were taken as observation variables to get the probability of patients in different survival periods.Basing on these results, a survival prediction score system including NMLN, margin, T stage and pathological grade was designed, the median survival time(month) of 4-9 points were 66.8, 42.4, 26.0, 9.0, 7.5 and 2.3, respectively, there was a statistically significant difference in the different points(P<0.01).@*Conclusions@#The survival prediction model of GBC based on Bayesian network has high accuracy.NMLN, margin, T staging and pathological grade are the top 4 risk factors affecting the survival of patients with advanced GBC who underwent curative resection.The survival prediction score system based on these four factors could be used to predict the survival and to guide the decision making of patients with advanced GBC.

Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo / Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

Photoacoustic Imaging for Differential Diagnosis of Benign Polyps versus Malignant Polyps of the Gallbladder: A Preliminary Study

OBJECTIVE: To investigate the feasibility of ex vivo multispectral photoacoustic (PA) imaging in differentiating cholesterol versus neoplastic polyps, and benign versus malignant polyps, of the gallbladder. MATERIALS AND METHODS: A total of 38 surgically confirmed gallbladder polyps (24 cholesterol polyps, 4 adenomas, and 10 adenocarcinomas) from 38 patients were prospectively included in this study. The surgical specimens were set on a gel pad immersed in a saline-filled container. The PA intensities of polyps were then measured, using two separate wavelength intervals (421–647 nm and 692–917 nm). Mann-Whitney U test was performed for the comparison of normalized PA intensities between the cholesterol and neoplastic polyps, and between the benign and malignant polyps. Kruskal-Wallis test was conducted for the comparison of normalized PA intensities among the cholesterol polyps, adenomas, and adenocarcinomas. RESULTS: A significant difference was observed in the normalized PA intensities between the cholesterol and neoplastic polyps at 459 nm (median, 1.00 vs. 0.73; p = 0.032). Comparing the benign and malignant polyps, there were significant differences in the normalized PA intensities at 765 nm (median, 0.67 vs. 0.78; p = 0.013), 787 nm (median, 0.65 vs. 0.77; p = 0.034), and 853 nm (median, 0.59 vs. 0.85; p = 0.028). The comparison of the normalized PA intensities among cholesterol polyps, adenomas, and adenocarcinomas demonstrated marginally significant differences at 765 nm (median, 0.67 vs. 0.66 vs. 0.78, respectively; p = 0.049). CONCLUSION: These preliminary results indicate that benign versus malignant gallbladder polyps might exhibit different spectral patterns on multispectral PA imaging.

¿Cuál es el rol de la cirugía en el tratamiento de un paciente con cáncer de la vesícula biliar estadio IIIb? / What is the role of surgery in the treatment of a patient with stage IIIb gallbladder cancer

El cáncer de la vesícula biliar (CaVB), es una neoplasias frecuente en nuestro país. La supervivencia (SV) global no supera el 40% a 5 años. La invasión de la túnica serosa y el estadio IIIB, se asocian a menor SV por considerarse una etapa avanzada de la enfermedad; por ello no hay consenso respecto del rol de la cirugía en estos casos. El objetivo de este artículo es analizar la evidencia existente respecto del rol de la cirugía en el tratamiento de un paciente con CaVB estadio IIIb. Se realizó una búsqueda sistemática de la evidencia disponible en la bases de datos Clinical Evidence, National Health Service, Health Technology Assessment, Tripdatabase, Cochrane Library y PubMed. Se buscaron a documentos de resumen de la evidencia (overviews, guías de práctica clínica (GPC, tablas GRADE), artículos secundarios (revisiones sistemáticas/RS) y artículos primarios (ensayos clínicos/EC y estudios observacionales/EO). Posteriormente, la evidencia se clasificó según la propuesta de la CEBM 2009. Se encontró un total de 420 documentos relacionados: 25 overviews, 15 tablas GRADE, 30 GPC, 37 RS, 99 EC y 214 EO. Al examinar en detalle todos los documentos; Se comprobó que sólo 17 estaban relacionados con los resultados del tratamiento quirúrgico de la CaVB en etapa III; y 5 se refieren a esta (3 EO, 1 GPC y una recomendación del NCI), pero ninguno al estadio IIIb. Existen pocos estudios relacionados, la mayor parte de ellos son de tipo retrospectivo, con un pequeño número de pacientes incluidos, de población y procedimientos quirúrgicos heterogéneos; por ende, es muy sacar conclusiones y realizar recomendaciones basadas en la evidencia existente.

Gallbladder cancer (GBC), is a common neoplasm in our country. The overall survival rate (OSR) does not exceed 40% at 5 years. The invasion of the serosa and IIIB stage, are associated with lower OSR seen it are an advanced stage of the disease, so there is no consensus on the role of surgery in this type ofpatients. The aim of this study is to analyze the existing evidence concerning the role of surgery in the treatment of a patient with stage IIIb GBC. A systematic search of available evidence in the databases Clinical Evidence, National Health Service, Health Technology Assessment, Tripdatabase, Cochrane Library and PubMed search was performed. Evidence summary documents (overviews, GRADE tables, Clinical Guidelines/CG), secondary articles (systematic reviews) and primary articles (Clinical trials/CT) and observational studies/OS) were searched. Subsequently, evidence was classified as proposed by EMBC 2009. A total of 420 related documents were found: 25 overviews, 15 GRADE tables, 30 CG, 37 SR, 99 CT and 214 OS. In reviewing at length all documents; It was verified that only 17 were related to results of surgical treatment of GC that stage III was mentioned and 5 refer to this (3 OS, 1 CG and a recommendation from NCI), but none of them to the IIIb stage. There are few related studies, most of them are retrospective, with a small number of patients included, heterogeneous population and surgical procedures; thereby, it is difficult to draw conclusions and make recommendations based on the evidence.

Predictive Factors of Malignant Potential in Gallbladder Polyps / 대한췌담도학회지

BACKGROUND/AIMS: Although the incidence of GB polyps is increasing with improved surveillance, the study of predictive factors of malignant potential has not been sufficient. The aim of this retrospective study is to investigate the predictive factors of malignant potential in GB polyps. METHODS: Among 3,159 patients with laparoscopic cholecystectomy in Chonbuk National University hospital January 2009 to December 2013, 437 patients confirmed GB polyps pathologically were enrolled. The patients were divided into two groups; one with benign GB polyp and another with GB adenoma and incidental GB cancer. RESULTS: Group I with benign GB polyp was seen in 359 patients. On the other hand, 53 patients with GB adenoma and 25 patients with GB cancer in gourp II were identified. The patients in group II had shown a significantly higher incidence of age older than 50 years (53/78, 67.9% vs. 163/359, 45.4%, p=0.001), size larger than 10mm (40/78, 51.3% vs. 37/359, 10.3%, p<0.001), and GB wall thickening (36/78, 46.2% vs. 77/359, 21.5%, p<0.001). The presence of GB stone had not shown significant differences between two groups (26/78, 33.3% vs. 96/359, 26.7%, p=0.378). CONCLUSIONS: Cholecystectomy should be considered for the patients with GB polyp with these predictive factors.

Clinical Characteristics of Early-Stage Gallbladder Cancer / 대한내과학회지

BACKGROUND/AIMS: Early detection of gallbladder (GB) cancer is essential for better survival rates. Most cases of GB cancer are diagnosed incidentally via pathology of the cholecystectomy specimen. Data on the clinical characteristics of early GB cancer are lacking. The aim of the current study was to investigate the clinical characteristics of early GB cancer to aid earlier diagnosis. METHODS: Sixty-four patients who were diagnosed with early GB cancer after surgical resection at the Samsung Medical Center were enrolled in this study. Clinical characteristics, preoperative diagnoses, preoperative tumor size, laboratory findings including carbohydrate antigen 19-9 (CA19-9) levels, imaging features, and survival rate were investigated. RESULTS: Clinical symptoms and serum tumor markers such as carcinoembryonic antigen and CA19-9 levels were not helpful indicators of early GB cancer. Radiologic modalities showed abnormal findings in every case of early GB cancer; a polypoid mass was the most common feature. Less common features included GB wall thickening, cholecystitis, and GB stones. The clinical outcome of early GB cancer was excellent. CONCLUSIONS: Screening with imaging modalities such as computed tomography (CT) or ultrasonography (US) is helpful in detecting early GB cancer. Even in the presence of GB wall thickening, cholecystitis, or GB stones on the CT or US, any abnormal findings should prompt careful examination and intensive follow up, considering the possibility of occult gallbladder cancer.

Two Cases of Xanthogranulomatous Cholecystitis and Gallbladder Cancer with Hemobilia / 대한소화기내시경학회지

Hemobilia is a rare upper gastrointestinal (GI) bleeding phenomenon usually caused by trauma but may occur due to various liver and pancreatobiliary diseases. Causes related to gallbladder disease include vascular disorders, malignancy, polyps, heterotopic GI mucosa, acalculous inflammation, and most commonly gallstones. Most cases are treated with a cholecystectomy. If hemobilia is detected, efforts must be made to exclude malignancy because hemobilia develops from both benign and malignant disease. Particularly in gallbladder disease with hemobilia, the possibility of gallbladder carcinoma should be considered. We report two cases of hemoblia by endoscopic retrograde cholangiopancreatography and duodenoscopy, with a review of the literature. The first case was xanthoglanulomatous cholesystitis and the second case was gallbladder cancer disclosed by cholecystectomy.

Surgical treatment and prognosis of gallbladder carcinoma in 96 cases / 中华肝胆外科杂志

Objective To study parameters influencing the prognosis of patients with gallbladder carcinoma.Methods A retrospective clinical analysis was conducted in 96 cases of gallbladder carcinoma treated in this hospital between 1993 and 2003.Results The overall 5-year survival rate of the patients was 6.32%.The 1-, 3-, and 5-year survival rates following radical resection for gallbladder carcinoma were 78.36%, 48.54%, and 23.87%, respectively.The survival rate was remarkably higher in the radical resection group than in others.Multivariate analysis revealed that depth of infiltration of the tumor and surgical procedure were markedly associated with prognosis.Conclusion Early diagnosis and radical resection are still the mainstay for long-term survival of the patients with gallbladder carcinoma.Appropriate perioperative care can improve survival rate.

A comparative study on Nevin and AJCC staging system for gallbladder carcinoma / 中华普通外科杂志

Objective To evaluate the clinical value of Nevin and AJCC staging system for gallbladder carcinoma. Methods In this study 90 patients diagnosed as gallbladder carcinoma underwent operation in Renji Hospital from February 2000 to October 2006. Patients were staged according to Nevin and AJCC staging system. The difference of survival rate, tumor resection rate, ratio of tumor-free resection margin and surgical procedures were analyzed. Results The survival rate, tumor resection rate and ratio of tumor-free resection margin decreased progressively with increasing Nevin and AJCC stage (P < 0. 05). There was no significant difference between the survival rate for Nevin Ⅲ or Ⅳ patients undergoing radical resection and simple cholecystectomy (P > 0. 05). In Nevin Ⅴ patients, the survival rate for radical and extensive radical resection patients was higher than for palliative patients (P < 0. 05). In AJCC Ⅲ patients, the survival rate for radical patients was significant higher than for palliative patients (P < 0. 05). Nosignificant difference was found between radical and palliative patients in survival time in AJCC Ⅳ (P > 0. 05). 52 patients in AJCC Ⅲ and Ⅳ were staged to Nevin Ⅴ according to Nevin staging system. The survival rate and resectable rate for the patients in AJCC Ⅲ were higher than in AJCC Ⅳ (P = 0. 0001, 0. 001 respectively). The rate of radical operation in AJCC Ⅲ was higher (P = 0. 001), and the rate of palliative operation in AJCC Ⅳ was higher (P = 0. 001). Conclusion Both Nevin and AJCC staging system are useful in the judgement of survival, reeectability, ratio of tumor-free resection margin and the optimal operation. AJCC staging system is more applicable for gallbladder carcinoma patients at advanced stage in terms of predicting prognosis.

Adenosquamous and squamous cell carcinoma of the gallbladder / 中华普通外科杂志

Objective To explorethe clinical features of adenosquamous carcinoma,squamous cell carcinoma and adenocarcinoma of the gallbladder. Methods A retrospective analysis of 112 patients with gallbladder carcinoma was performed.The clinical features and outcomes of 11 patients with either adenosquamous or squamous cell carcinoma were compared with the other 101 patients of adenocarcinoma.Results The rate of tumor with T3 or T4 stage in adenosquamous/squamous cell carcinoma group and adenocarcinoma groupwere 100%and 53%(X2=7.013,P=0.008).The rate of distant metastasis in adenosquamous/squamous cell carcinoma group and edenocarcinoma at advanced stage(T3 or T4 stage)group were 0 and 35%(X2=3.900,P=0.048).The rate of lymph node invasion were 82% and 87%(X2=0.000,P=1.000).The rate of gastrointestinal tract invasion in adenosquamous/squamous cell carcinoma group and adenocarcinoma at advanced stage(T3 or T4 stage)group were 45% and 15%(X2=3.618,P=0.054).The median survival time for the two groups were 5 months and 4 months respectively(X2=0.359,P=0.549).Condusiom Adenosquamous/squamous cell carcinoma of the gallbladder had high local invasion capacity and usually were diagnosed at an advanced stage.The distant metastasis rate of adenosquamous/squamous cell carcinoma of the gallbladder was lower compared with adenocarcinoma.The lymph node invasion mte of adenosquamous/squamoua cell carcinoma was similar to adenocarcinoma.

The Overexpression of p53,bcl-2,EGFR Oncoproteins in Tissue of Adenomyomatosis / 中国医师杂志

Objective To explore the relationship between cholecystoadenomyomatosis and gallbladder cancer.Method The expression of p53,bcl-2,EGFR oncoproteins were examined by method of immunohistochemistry in benign lesions and carcinomas in gallbladder.Results The study revealed that overexpressions of p53,bcl-2,EGFR oncoproteins were detected in 0,4,3 cases of 21 patients with chronic cholecystitis;0,5,3 cases of 20 patients with cholecysto-adenomyomatosis and 16,14,11 cases of 25 patients with adenocarcinoma of the gallbladder respectively.There were significantly differences in single or multiple oncogene expression rates among groups,but not in chronic cholecystitis to adenomyomatosis.Conclusions These results suggests that oncogenic changes of p53,bcl-2,EGFR expression may play a role in gallbladder oncogenesis,cholecystoadenomyomaltosis should not be considered as an important precancerous lesion of gallbladder.

Clinical analysis of primarily gallbladder carcinoma in 36 cases / 临床外科杂志

Objective To improve the diagnosis and therapeutic efficacy of primary gallbladder carcinoma.Method A retrospective clinical analysis was made in 36 cases of gallbladder carcinoma treated in our hospital from 1986 to 2001.Results 74.3% cases were definitely diagnosed before operation. 64% patients were accompanied with gallstone.17% cases were misdiagnosed.Ultrasonography and CT were the main method of diagnosis of gallbladder carcinoma.26 cases underwent surgical treatment with a resection rate of 55.6%.Postoperative 1 and 5 years survival rate of resection were 36% and 10%.Conclusions Radical resection is the mainstay for stage Ⅰ,Ⅱ,Ⅲ gallbladder carcinoma,and comprehensire treatment is fit for stage Ⅳ,Ⅴ.Early diagnosis and radical resection are the efficient methods for long-term survival of the patients with gallbladder carcinoma.Cholecystectomy on the time is necessary to the high-risk gallstone.

Surgical Treatment of Primary Gallbladder Carcinoma / 中国医师杂志

Objective To explore how to improve the diagnosis and surgical treatment of primary gallbladder carcinoma. Methods The clinical data of 59 patients with primary gallbladder carcinoma underwent operative treatment in our hospital from January 1985 to December 1999 were retrospectively analyzed. Results There were 22 males and 37 females in this series (M:F=1:1.68). 59%(35/59) patients were complicated by gallstone. Right upper quadrant abdominal pain, jaundice and abdominal mass were the major clinical manifestations. 34 cases underwent cholecystectomy with 57%(34/59) resection rate. Pathological examination showed that gallbladder carcinomas accounted for 94%. Postoperative 1-,3-,5-year survival rates were 36%(21/59), 20%(12/59)and 10%(6/59), respectively. The postoperative survival rate of the early stage patients was higher than that of the advanced patients(P