Clinicopathological Evaluation of Surgical Treatment for Early Gallbladder Cancer.

Abstract

We evaluated the therapeutic principles for early gallbladder cancer based on clinicopathological characteristics and outcomes in 27 patients encountered at the Kurume University Hospital between January, 1975 and December, 1999. Concerning the depth of wall penetration, 15 patients had mucosal cancers (m-cancers), and 12 patients muscularis propria cancers(mpcancers). The gross patterns were Ip (pedunculated) in 16 patients, Is (sessile) in 3 patients, Ila (flat elevated) in 4 patients, and Ilb (flat) in 4 patients. The operative procedure used was cholecystectomy (C) in 12 patients, 4 of whom underwent lymph node dissection. Full-thickness cholecystectomy (FTC) was carried out in 3 patients, one of whom had lymph node dissection. Combination of C and gallbladder bed resection (GbBR) was performed in 7 patients, 6 of whom had lymph node dissection. Combination of C and bile duct resection (BDR), and lymph node dissection was performed in 1 patient. Combination of C and GbBR and BDR, and lymph node dissection was performed in 6 patients. All the patients who underwent lymph node dissection were negative for metastasis. Of the 27 patients, 2 underwent laparoscopic operation: one with m-cancer was 79 years old, and the other with mp-cancer 86 years old. In the m-cancers, no lymphatic, venous or perineural infiltration was observed. In contrast, in the mp-cancers, lymphatic and venous infiltration each were observed in 4 patients (33.3%), although no perineural infiltration was observed. A diagnosis of gallbladder cancer was made postoperatively in 6 patients, of whom 4 had the Ilb pattern and all were complicated by gallstone, indicating the difficulty of diagnosing the Ilb pattern. The 5-year survival rates for the m-and mp-cancers were as high as 90.9% and 80.8%, respectively. As a curative surgical technique for m-and mp-cancers, lymph node dissection should be performed in addition to FTC, GbBR, and BDR, in combination. When a postoperative histopathologic diagnosis of gallbladder cancer has been made, no second-look operation should be performed for m-cancers, but lymph node dissection of up to the second group should be performed for mp-cancers in a second-look operation.

The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry

“…The lymphatic drainage pathway has been well described by Ito et al [29] and Uesaka et al [30]. Kinoshita et al [31] reported that lymphatic and venous infiltrations were present in 33.3% of T1b gallbladder carcinomas despite the absence of lymph node metastasis and perineural infiltration [31]. Mizumoto et al [32] reported lymph node metastasis in 15.7% and lymphatic infiltration in 18.4% of T1b carcinomas.…”

Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry

“…A rational approach that recommends wedge resection of the liver involving the gallbladder bed as well as a regional lymph node dissection of the hepatoduodenal ligament was proposed in 1954 [36], and regional lymph node dissection was recommended in 1963 [37]. Lymphatic and venous infiltrations were reported to be present in 33.3% of T1b cancers [38], and lymph node metastasis and lymphatic infiltration was shown in 15.7 and 18.4% of T1b cancers, respectively [39]. Another study found no lymph node metastasis or lymphatic or perineural infiltration in the T1a tumors [40].…”

Early Gallbladder Cancer: Clinical, Morphological, Therapeutic and Evolutionary Aspects

“…The prognosis of this form of gallbladder cancer is excellent with a cholecystectomy [2,11,14,16,18] and radical cholecystectomy. The 5 year survival fluctuates between 70% and 100% [2,7,8,11,14,[16][17][18][19][20][21]26]. In our experience, we encountered one death (radical cholecystectomy) not related to the surgery (myocardial infarction).…”

“…For others, the cholecystectomy is sufficient only for the pT1a form (mucosal tumor). A radical resection (cholecystectomy associated with hepatectomy and lymphadenectomy) is indicated for the pT1b form (involvement of the muscularis layer) [20][21][22]. This controversy seems to found its explanation in the fact that these authors find a node extension in the PT1b form [14,20].…”

“…A radical resection (cholecystectomy associated with hepatectomy and lymphadenectomy) is indicated for the pT1b form (involvement of the muscularis layer) [20][21][22]. This controversy seems to found its explanation in the fact that these authors find a node extension in the PT1b form [14,20]. For Shimizu et al [23] and Shukla et al [24], the best treatment for PT1b is a radical cholecystectomy and then the reoperation is recommended.…”