Comparison between early gall bladdercancer and advanced gall bladdercancer in terms of clinicopathologic factors: large volume tertiary center experience

Background:Early diagnosis of gallbladder cancer (GBC) which enables to surgical resection is key for improve prognosis. Aim of this study was to investigate clinical features of early GBC patients compare to advanced ones.Methods:We retrospectively reviewed medical records of all pathologically confirmed primary GBC patients between in single tertiary referral center.Results:250 patients (57.3%) were early GBC (stage IandII) and 186 (42.7%) were advanced GBC (stage IIIandIV). Less patients with early GBC had symptom at initial diagnosis (69.2% versus90.8%, p<0.001). Large number of patients with early GBC were diagnosed GBC incidentally after surgical resection which initially suspected benign gallbladder polyp or symptomatic gallbladder stones (71/250, 28.4% versus7/186, 3.8%) (p<0.001). Patients who initially diagnosed gallbladder stone or cholecystitis tended to more advanced than gallbladder polyp.Conclusions:There were no definitive symptoms which can detect early GBCs. Large number of early GBCs were diagnosed incidentally and many of these initially diagnosed with or accompany with benign cholecystic disease. Careful examination should be performed before diagnosis and after treatment, even in patient with vague symptom or benign cholecystic disease without elevated tumor markers.

Clinical Feature of Incidental Gallbladder Cancer Diagnosed after Laparoscopic Cholecystectomy due to Gallbladder Polyps

PURPOSE: Laparoscopic cholecystectomy (LC) has been accepted as one of the best methods for treatment of patients with gallbladder (GB) disease. Diagnosis of malignant gallbladder disease by radiologic finding is possible; however, some cases can be diagnosed incidentally as cancer of the gallbladder after a LC. Prognosis of GB cancer is very poor; however, a complete recovery can be achieved with early detection and resection. This study was performed in order to determine incidence and clinical features of incidentally detected GB cancer after LC. METHODS: A retrospective analysis of 10 Patients diagnosed as GB polyp prior to surgery, but diagnosed incidentally as GB cancer after LC from January 2002 to February 2011 was conducted. RESULTS: Of 124 cases of GB polyp, 10 patients were diagnosed as incidental GB cancer, with incidence rate of approximately 8%. Mean age was 60.9. Mean diameter of polyps was 1.1 cm, with six cases of pedunculated polyps, and four cases of sessile polyps. GB stones were diagnosed by radiologic study prior to surgery in four patients. Four patients had pT1a tumors (limited to mucosa) and six patients had pT2 (invaded perimuscular tissue) or pT3 (perforated serosa, direct invasion into liver). CONCLUSION: Malignancy potential of GB polyps was 8%. Surgeons should be aware of the possibility of malignancy and frozen section biopsy should be performed for examination of suspected GB tissue. If needed, radical cholecystectomy should be performed.

Relationship between COX-2 Expression and Clinicopathologic Data of GB Cancer / 한국간담췌외과학회지

BACKGROUND/AIMS: Gallbladder carcinoma has been associated with a dismal overall prognosis. Tumorigenesis of gallbladder carcinoma is complex and not completely understood. An association of gallbladder carcinoma with cholelithiasis or an anom alous arrangement of the panceraticobiliary duct suggests that long-term inflammation may modulate tumorigenesis and progression of carcinoma. COX-2 is a rate limiting enzyme of PG synthesis and related to chronic inflammation. Several report suggested the close relationship between and COX-2 and GB cancer. METHODS: We reviewed the clinical records of sixty-two patients with GB cancer who had undergone operation from January, 1990 to December, 1999 at Hanyang University Hospital. COX-2 expression of GB cancer were evaluated with im\munohistochemical staining and expression intensity was graded on a scale of 0-2 RESULTS: There were 62 patients, whose mean age was 52.5 years. The ages ranged from 28 years to 84 years. There were 27 male patients and 35 female patients. Generally, COX-2 expression was found in chronic inflammatory area and its level increased in dysplastic area and mucosal tumor. stromal tumor showed relatively weaker COX-2 expression level. COX-2 expression is related to depth of tumor invasion, lymph node metastasis, stage (TNM, Nevin) in a negative way. CONCLUSION: Early stage of GB cancer shows relatively increased level of COX-2. Its increased level means COX-2 can modulate early stage of GB cancer carcinogenesis. COX- 2 inhibitor, cancer chemopreventive agent in colon cancer, can be regarded as same one in GB cancer.

The Results of Curative Reoperation for Recurrent Cancer of the Extrahepatic Biliary Tract

PURPOSE: Local recurrence, following a resection for cancer of the gallbladder (GB) and bile duct, is usually incurable; with 2nd curative surgery being almost impossible. To determine the feasibility and significance of 2nd curative surgery, our experiences are presented in this study. METHODS: The medical records and clinical outcomes of 4 patients that underwent a re-resection for recurrent cancer of the extrahepatic biliary tract were retrospectively reviewed. RESULTS: The mean age of the four patients was 51.5 years. One patient that had a recurrent disease at the intrahepatic and intrapancreatic bile duct, 66 months after a segmental resection of the bile duct for common bile duct (CBD) cancer, underwent a hepatopancreatoduodenectomy. The second patient had a recurrent tumor mass in the CBD originating from in a cystic duct, 11 months after a cholecystectomy, and underwent a segmental resection of the bile duct. The third patient had a recurrent disease in the distal CBD, 28 months after a right hepatectomy for a Klatskin tumor, and underwent a pylorus-preserving pancreatoduodenectomy. The gross type of the above 3 cases was a papillary tumor. The fourth patient had a recurrent tumor mass of the liver parenchyma, close to the previous resection margin, 16 months after a cholecystectomy and wedge resection of the GB bed at another hospital for GB cancer, and underwent a wider wedge resection of the GB bed. There were no operative mortalities or morbidities. All patient are still alive after 46, 63, 9 and 30 months, respectively, without recurrence after the reoperation. CONCLUSION: It is concluded that a surgical re-resection is possible in selected patients with recurrent bile duct cancer, mostly of the papillary type. A primary operation for bile duct cancer should be performed with a wide surgical margin, and secondary curative surgery should be considered whenever possible in cases of recurrence.