ObjectiveThe objective of this study was to evaluate the benefit of an aggressive approach to gallbladder carcinoma on long-term survival. Summary Background DataRecent studies have shown that an aggressive surgical treatment of bile duct carcinoma can be associated with a surprising long-term survival. However, recent data on gallbladder carcinoma are not available. MethodsData were obtained from a questionnaire sent to 73 institutions in France, Europe, and overseas, and they were analyzed retrospectively. The review included an analysis of patient sex and age, associated hepatobiliary diseases, symptoms and signs, diagnostic tests, operative management, pathology reports, and survival. ResultsSeventy-eight per cent of the patients were woman, and 22% were men (p < 0.001). Gallstones were present in 86% of the cases. Four per cent of the patients had Tis stage lesions, 1 1% had Ti to T2 stage lesions, and 85% had T3 to T4 stage lesions (p < 0.001). Pain was the most frequent symptom (77%). Twenty-three per cent of the patients underwent curative operations, and 77% had a palliative treatment (25% of the patients underwent exploratory laparotomy). Exploratory laparotomy was followed by the highest mortality rate (66%), and older patients (> 70 years) had a higher operative risk (p < 0.04). The overall median survival was 3 months, and long-term survival correlated with the cancer stage (Tis, > 60 months; Ti to T2, > 22 months, and T3 to T4, 2 to 8 months). No differences were observed among the different surgical procedures adopted. ConclusionsNo progress has been made in the last 10 years in the treatment of gallbladder malignancies.Carcinoma of the extrahepatic biliary tract has always However, in the last decade, we have observed imbeen associated with a dismal prognosis. This is essen-provements in surgical, anesthetic, and intensive care tially the result of the slow and asymptomatic growth of techniques that have allowed us to ameliorate both the the neoplasm that infiltrates the surrounding structures, pre-and postoperative general condition of these pasuch as the portal vein and hepatic artery, making a cu-tients'2 and offer a wider range of surgical options. Sevrative surgical treatment almost impossible. eral authors recently showed that an aggressive surgical 275

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In patients undergoing PD, NJEEN was associated with an increased overall postoperative complications rate. The frequency and the severity of POPF were also significantly increased after NJEEN. In terms of safety and feasibility, NJEEN should not be recommended.

Elective laparoscopic sigmoidectomy for diverticulitis is feasible and is safe. The complication and mortality rates are similar to those observed after open procedures. For experienced surgical teams, laparoscopic colonic resection is a good approach for selected patients suffering from symptomatic diverticulitis.

In hemodynamically stable patients with blunt abdominal trauma, laparoscopy safely and effectively identifies small bowel injuries. Early recognition of these injuries and timely surgical treatment offer the best prognosis.