Natural history of gallbladder carcinoma: clinical and pathologic factors.
OBJECTIVE
To identify clinical and pathologic differences between nonadvanced (resectable by cholecystectomy) gallbladder adenocarcinomas (GBA) and advanced (nonresectable) GBA.


METHODS
Twenty-nine cases of GBA were divided into two groups. Patients in group A (n = 15) underwent complete tumor resection by cholecystectomy, and those in group B (n = 14), incomplete or no resection of the tumor. Clinical (age, sex, pain, jaundice, weight loss, abdominal mass, fever), biological (anemia, hypoalbuminemia, cholestasis-cytolysis), diagnostic (ultrasound, intraoperative, postoperative) and pathologic (tumor size and differentiation status) aspects were compared in the two groups.


RESULTS
Clinical and biological factors showed no significant differences between the two groups. Overall effectiveness of GC diagnosis before the postoperative pathologic examination was 6.7% in group A and 57.1% in group B (p < 0.001). Advanced tumors (T3-T4) were found in group B, and nonadvanced tumors in group A (T1-T2, 66.7%). In group B well-differentiated tumors (10 cases) predominated, whereas poorly-differentiated tumors predominated in group A (19 cases, p < 0.01).


CONCLUSIONS
The preoperative diagnosis of GBA is difficult, except in advanced cases. No clinical differences exist between completely resected and nonresectable tumors. Resected tumors are usually a postoperative pathologic finding, and are usually nonadvanced and well differentiated.
Hidalgo Grau
L A
LA
Servicio de Cirugía General, Consorci Sanitari de Mataró, Barcelona.
Badia Pérez
J M
JM
Heredia Budó
A
A
Admella Salvador
C
C
Muns Sala
R
R
Gubern Nogués
J M
JM
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D003937:Diagnosis, Differential; D005260:Female; D005704:Gallbladder / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies