title: Mirizzi syndrome and gallbladder cancer.
abstract: OBJECTIVE
  Mirizzi syndrome is a rare complication of gallstone disease (GSD). The association of Mirizzi syndrome and gallbladder carcinoma (GBC) is not well understood. We report our experience of gallbladder carcinoma in patients with Mirizzi syndrome.
  
  
  METHODS
  We performed a retrospective analysis of the records of patients with Mirizzi syndrome who underwent cholecystectomy at a tertiary care hospital with special emphasis on patients who were found to harbor GBC. Patients with Mirizzi syndrome with associated GBC were compared with those who had Mirizzi syndrome alone and those with uncomplicated GSD.
  
  
  RESULTS
  Out of 4,800 cholecystectomies, Mirizzi syndrome was found in 133 (2.8%). Seven (5.3%) patients with Mirizzi syndrome had associated GBC, as compared to only 1% in patients with GSD. GBC was detected on final histology after cholecystectomy in 5 patients, and was detected preoperatively and intraoperatively in 1 patient each. Patients with Mirizzi syndrome with associated GBC were older (60 vs 50 years; P <or= 0.0001) and had a longer duration of symptoms (59 vs 24 months; P = 0.002) as compared to those with Mirizzi syndrome alone. However, presenting clinical features were not different in these two groups.
  
  
  CONCLUSIONS
  There was a higher incidence of GBC in patients with Mirizzi syndrome than in patients with uncomplicated GSD. There were no clinical features to differentiate these patients with GBC from those with Mirizzi syndrome alone, except that they were a decade older and had longer duration of symptoms. In the majority, the diagnosis of GBC was made on final histology, after cholecystectomy; hence, this group of patients with GBC are to be treated like any other patients with incidental GBC.
authors.affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, UP, India.
authors.forename: Theegala L V D
authors.initials: TL
authors.lastname: Prasad
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Sadiq S
authors.initials: SS
authors.lastname: Sikora
authors.forename: Rajan
authors.initials: R
authors.lastname: Saxena
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Kapoor
mesh_terms: D000368:Aged; D001658:Biliary Fistula / Q000453:epidemiology*; D003137:Common Bile Duct Diseases / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome