The records of patients with primary carcinoma of the gallbladder treated at Charity Hospital, New Orleans, Louisiana, from 1965 through 1978 were reviewed. Eighty patients had histologically proven primary carcinoma of the gallbladder. Sixty-nine patients had sufficient data available for evaluation. Only one patient (1.4%) was clinically free of disease at five years. Surgical procedures were performed in 45 of the 69 patients. The remainder of the patients had their disease proved at autopsy. Thirty-five patients had widespread metastatic disease at the time of operation. None of these patients survived more than one year. Only 10 patients had potentially curable lesions. The diagnosis of carcinoma of the gallbladder was not made at operation in eight of these patients. The only five-year survivor was in this subgroup. This patient had papillary adenocarcinoma confined to the mucosa and muscularis, and had a cholecystectomy alone. This report reinforces the difficulty in diagnosis and the dismal prognosis for patients with primary carcinoma of the gallbladder. Intraoperative examination of the gallbladder, earlier operation for documented gallbladder disease, and more aggressive surgical therapy should improve survival figures.

Introduction Despite widespread adoption by the surgical community, high-quality prospective data supporting the practice of laparoscopic cholecystectomy (LC) for the treatment of biliary dyskinesia (BD) is lacking. Methods Adult patients meeting criteria for diagnosis of BD (Rome III symptoms, normal ultrasound, gallbladder ejection fraction<38%) were randomized to either LC or a trial of non-operative (NO) therapy with a low-dose neuromodulator (amitriptyline 25mg/day). Patients in the NO arm were allowed to cross over to the surgical arm and remain in the study for any reason. Besides collection of basic demographics and medical/surgical history, patients were administered a standardized quality of life (QOL) assessment (SF-8) and a symptom-specific questionnaire (Rome III criteria) at enrollment and monthly through the study to assess the effect of treatment on biliary symptoms and overall QOL. Results Thirty patients were enrolled over 12 months (15LC, 15NO). In the LC group, 13 underwent LC, 1 refused surgery, 1 withdrew. In the NO group, 14 crossed over to the LC group (of which 13 had LC), yielding 26 patients who underwent LC. SF-8 physical scores (PCS-8) were significantly improved at both the first and last follow-up visits (p<0.0001, p=0.0003 respectively). SF-8 mental scores (MCS-8) were also significantly improved at both the first and last follow-up visits (p=0.0187, p=0.0017 respectively). With median follow-up of 12 months [range 3–14], all 26 reported relief of pain. Conclusions This pilot study raises doubts regarding the feasibility of a randomized trial, presumably due to both clinician and patient bias toward LC and the lack of “gold-standard” non-operative treatments. However, these prospective data indicate that, with careful patient selection (standardized symptom criteria/imaging methodology), LC results in pain relief and significant improvement in QOL in BD patients. Further prospective study of these findings is warranted.