Surgical approach to gallbladder cancer
Alp Gürkan, Serdar Kaçar, Cezmi Karaca, Bülent Özdemir, Can Varılsüha, Nihat Zalluhoğlu
S.B. Tepecik Eğitim ve Araştırma Hastanesi, 3. Genel Cerrahi Kliniği, İZMİR
Purpose: In this study; the patients in stages 2-3, whom extended cholecystectomy were performed were compared to the patients in same stages whom palliative procedures were done, in terms of survival.
Background: Although gallbladder cancer is not seen as frequent as the other gastrointestinal cancers, it is not a rare entity. Usually it is diagnosed in late stage; but in early stage, there is no consensus about its surgical treatment strategies.
Material and Method: 34 patients had undergone surgical procedures for gallbladder adenocarcinoma between June 1993 and April 2004. 4 (12%), 2 (6%), 8 (24%), 13 (38%) and 7 (20%) patients were in stages 1, 2, 3A, 3B and 4, respectively.
Results: In stage 1, cholecystectomy and extended cholecystectomy were performed in 3 and 1 patients, respectively. Extended cholecystectomy was done in both of the patients in stage 2 and 9 of the 21 patients in stage 3. Palliative procedures were performed in all 7 cases in stage 4. Postoperative complications were seen in 7 patients. 2 patients died in early postoperative period due to multi-organ failure. 23 (67%) patients died with local recurrence (n:18) or with distant metastasis (n:5) during their follow-up period. Among 23 patients in stages 2-3, 11 (48%) patients had undergone curative-intended surgery. The 6 (55%) cases out of 11 were still alive and median survival time of these patients was found to be 30.9±9.5 months. All the 12 patients in the similar stages, whom palliative procedures were performed, died during follow-up period and the median survival time was 6.1±1.2 months. Both groups were statistically different in terms of survival (p= 0.012).
Conclusion: Extended cholecystectomy effected survival in the patients in stages 2 and 3. In the patients in stage 1, we were not able to reach a conclusion due to shortage of patients in this stage.
Keywords: extended cholecystectomy, gallbladder cancer, hepatic resection, gallbladder