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Panminerva Medica 2002 September;44(3):227-31

lingua: Inglese

Surgery for carcinoma of the gallbladder. Our experience

Leone N., De Paolis P. *, Garino M. *, Brunello F., Carrera M. *, Pellicano R., Fronda G. R. *, Bumma C. **, Rizzetto M.

Depart­ment of Gas­troen­te­rol­o­gy and *B Sur­gery, Ospe­dale S. Gio­van­ni Bat­tis­ta, ­Turin, Ita­ly
**Depart­ment of Med­i­cal Oncol­o­gy Ospe­dale S. Gio­van­ni Vec­chio, ­Turin, Ita­ly


Back­ground. Car­ci­no­ma of the gall­blad­der is a gas­troin­tes­ti­nal malig­nan­cy ­with a ­very ­poor prog­no­sis. The 5-­year sur­vi­val ­rate ­amounts to ­less ­than 5% in ­most ­series. In ­this ­study we ­reviewed the ­results of sur­gi­cal treat­ment for gall­blad­der car­ci­no­ma ­with spe­cial ref­er­ence to extend­ed rad­i­cal pro­ce­dures.
Meth­ods. ­Between 1995 and 2000 we ­enrolled 36 ­patients (17 ­males and 19 ­females), 24 of ­whom ­were treat­ed ­with sim­ple chol­e­cys­tec­to­my and 12 ­with rad­i­cal resec­tion (par­tial hep­a­tec­to­my, region­al lym­phad­e­nec­to­my, and com­mon ­bile ­duct resec­tion). The ­tumours ­were clas­si­fied by ­stage ­using the cri­te­ria of the Amer­i­can ­Joint Com­mit­tee on Can­cer (­AJCC). Stag­es, oper­a­tive pro­ce­dures, ­results of path­o­log­ic exam­ina­tions and the out­come of the resect­ed cas­es ­were ­reviewed.
­Results. ­There ­were 2 post­op­er­a­tive ­deaths (0.55%). The ­mean fol­low-up peri­od was 19.1 ­months (­range 1-60). For ­stage I and II dis­ease extend­ed chol­e­cys­tec­to­my had a bet­ter ­result ­than sim­ple chol­e­cys­tec­to­my: the 5-­year sur­vi­val ­rates ­were 38.4 ver­sus 19%, respec­tive­ly. For the ­patients ­with ­advanced ­stage III or IV gall­blad­der car­ci­no­ma, a sig­nif­i­cant advan­tage of sur­vi­val result­ed in ­case of liv­er resec­tion as com­pared to sur­gi­cal treat­ment with­out liv­er resec­tion: the 5-­year sur­vi­val ­rates ­were 20 and 0%, respec­tive­ly.
Con­clu­sions. The sur­vi­val of ­stage I-II ­patients was ­good. For the ­patients in high­er stag­es the prog­no­sis was sig­nif­i­cant­ly ­worse. In ­these cas­es ­more aggres­sive sur­gery may be need­ed.

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