Current situation in the treatment of gallbladder cancer. Considerations on the utility of an extended resection.
Twenty-two of the 25 patients with carcinoma of the gallbladder seen during the last 9 years have been analyzed for survival in relation to treatment and disease stage. All patients were classified according to Nevin's staging scheme, and a correct preoperative diagnosis was made in 31.8% of cases. The median survival of the 8 stage V patients who had no surgery or alternatively underwent only limited excision of the tumor was 16.5 days (for the two patients receiving explorative laparotomy); 2 months for a patient undergoing a debulking operation and 5 months for the 5 patients receiving nonoperative biliary drainage. Survival in patients undergoing cholecystectomy, whether associated with biliary drainage or not has proved to be adversely affected by the stage of the malignancy, the stage I patient being alive and well at 2 years whereas the stage II patient died after 5 and a half months, the stage III patient survived 1 year and the stage IV patient 1 year and 6 months. Stage V patients receiving simple cholecystectomy (1 case) or associated with biliary drainage (5 cases) died 16.5 days and 4.5 months following surgery, respectively. More radical operations have been performed in 4 other stage V patients, who had resection of segments IV and V (2 patients, one of them survived 3 months and the other is still alive and well at 5 months), resection of segment IV (survival was 15 days), and right hepatectomy (survival 7 months). In view of our limited experience no statistically significant conclusions can be drawn.(ABSTRACT TRUNCATED AT 250 WORDS)
D'Amico
D
D
2nd Department of Surgery, University of Padova.
Bassi
N
N
D'Erminio
A
A
Brigo
L
L
Boccagni
P
P
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D004322:Drainage; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000379:methods; D015996:Survival Rate