Hallazgos en reintervenciones quirúrgicas por cáncer de la vesícula biliar en pacientes con y sin quimio-radiación preoperatoria / Pathological findings in surgical reinterventions for gallbladder cancer in patients with and without preoperative chemo and radiotherapy

ABSTRACT

Background: The usefulness of surgery in the treatment of gallbladder cancer has not been clearly established. The benefits of chemo and radiotherapy are similarly dubious. Aim: To report the pathological findings in patients subjected to surgical reinterventions for gallbladder cancer. Patients and methods: We report 54 patients with gallbladder cancer that were subjected to a second surgical intervention for resection of liver segments IVb and V and lymph nodes corresponding to the liver hilar, portal, peripancreatic, celiac artery and periaortic territories. Thirteen of these patients were subjected to preoperative chemo-radiotherapy (4500 Gy and 5-fluouracil 500 mg/m2). Results: Lymph node metastases were found in 25 and 38 percent, and liver metastases in 25 and 28 percent of patients with or without chemo-radiotherapy respectively. The most frequent pathological findings attributed to radiation in the liver were fatty infiltration in 75 percent of cases, vascular transformation in 83 percent of cases and minimal periportal lymphocyte infiltration in 40 percent of cases. Lymph nodes were atrophic in 67 percent of cases and had foci of cortical necrosis in 46 percent of cases. Three cases had regional lymph node and liver metastases. Most tumor cells were viable. Conclusions: No differences in the number of lymph node or liver metastases were observed between patients with and without chemo-radiotherapy. No effect of the treatment on residual tumor was observed either