TITLE:
Early Gallbladder Cancer: Clinical, Morphological, Therapeutic and Evolutionary Aspects
AUTHORS:
Berkane Salah, Abid Larbi
KEYWORDS:
Early Cancer; Gallbladder Cancer; Ultrasonography; Expert Radiologist; Surgical Treatment
JOURNAL NAME:
Surgical Science,
Vol.4 No.11,
November
26,
2013
ABSTRACT: Introduction: The early cancer of gallbladder is an entity which is not well
recognized currently. It is a cancer which does not extend beyond the
muscularis layer of the gallbladder and it is characterized in almost of cases
by the absence of lymph node and visceral invasion. Patients and Method: We have conducted this retrospective study of
all our cases of early gallbladder cancer treated in our surgical unit. We have
studied these through clinical, morphological, therapeutical and evolutionary
aspects. Results: Of 202 gallbladder
carcinoma, 33 cancers were classified as early cancer. 25 were females and 8
were males. The mean age was 56.4 years (41 -70 years).
All patients were free of gallbladder cancer symptoms and all except one had
normal CEA and CA19.9. 2 patients had synchronous tumors (one colonic cancer
and one rectal cancer). For 16 patients, the diagnosis was
done by ultrasonography and 17 by histological examination of the specimen
removed for biliary lithiasis. 8 patients had PT1a tumor (confined only to
mucosa) and 25 had PT1b tumor (tumor infiltration of the muscular layer). For
19 patients who benefited from extensive lymphadenectomy, only
one (5.3%) had lymph node infiltration. 16 patients had a simple
cholecystectomy and in two cases, the cholecystectomy was associated with bile
duct resection. 17 patients had hepatectomy with extensive lymphadenectomy. 2 patients
had a simultaneous right colectomy and abdominoperineal resection and another
one benefited from choledocal cyst resection. 3 patients benefited from stone
removal from bile duct and two had tumor removal from bile duct (ruptured tumor
in the bile duct). 1 patient (3.7%) died in postoperative course (hospital mortality).
In the follow-up period, 4 patients died from intercurrent causes. Two patients
presented a recurrence at 14 and 36 months and died respectively at 19 and 42 months.
One patient presented a bile duct cancer at 66 months. She died at
78 months after palliative treatment. Currently, 22 patients
(66.7%) are still alive without recurrence with mean and median survival of 53
and 31 months. Conclusion: Early
gallbladder cancer is an entity which must be known by the radiologist
and the surgeon. Recognized on time and well treated, early gallbladder cancer
can be cured and its prognosis is excellent.