Gallbladder cancer presenting with acute cholecystitis: a population-based study.
BACKGROUND
The role of laparoscopic cholecystectomy (LC) in acute cholecystitis remains controversial. The aim of the present study was to determine the incidence, clinicopathological characteristics, and outcome of patients with gallbladder cancer presenting with acute cholecystitis.


METHODS
We performed a retrospective analysis of patients with gallbladder cancer who presented with acute cholecystitis and were treated at the public hospitals in Hong Kong between 1998 and 2002.


RESULTS
Among 2,700 patients with acute cholecystitis managed with cholecystectomy (1,347 open and 1,353 LC), 63 patients (2.3%) were found to have gallbladder cancer. There were 44 women and 19 men with a mean age of 74.7 (+/-12.8) years. Adenocarcinoma (90.5%) was the most common cancer. The overall median survival was 5 months (95% CI = 2.6-7.4). The 5-year survival rate was 20.8%. Laparoscopic cholecystectomy was attempted in 11 patients and was completed successfully in six of them. There was no difference between the LC and open groups in the complication rate, hospital mortality rate, or survival rate.


CONCLUSIONS
In the ethnic Chinese population of Hong Kong, the incidence of gallbladder cancer presenting with acute cholecystitis is higher than the same finding in patients undergoing elective cholecystectomy for cholelithiasis. Long-term survival is possible because such patients may be diagnosed at an early stage of the disease.
Lam
C M
CM
Central Surgical Audit Unit, Hospital Authority, Hospital Authority Building, 147 B Argyle Street, Kowloon, Hong Kong. lamcm@hkucc.hku.hk <lamcm@hkucc.hku.hk>
Yuen
A W
AW
Wai
A C
AC
Leung
R M
RM
Lee
A Y
AY
Ng
K K
KK
Fan
S T
ST
D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D002769:Cholelithiasis / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000601:surgery; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D015993:Life Tables; D008223:Lymphoma / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome