The records of 111 patients with gallbladder carcinoma operatively treated between 1972 and 1984 were retrospectively reviewed. Fifty-seven percent of patients had distant metastases; another 16% had nodal metastases without distant disease. Median survival was 0.5 years, and 5-year survival was 13%. Clinical jaundice, tumor stage, and tumor grade were all predictive of patient outcome. DNA ploidy, measured in 70 patients, was not a prognostic indicator. In 36% of patients, cholecystectomy (20%) or radical cholecystectomy (16%), which included adjacent liver and regional lymph node resection, was potentially curative. Median survival for patients undergoing radical procedures was 3.6 years, and survival was 0.8 years for patients following cholecystectomy. The 5-year survival rates were comparable (33% vs 32%). While radical cholecystectomy may benefit individual patients and can be accomplished with low morbidity, there was no overall survival advantage compared with cholecystectomy.

Carcinoma of the gallbladder. Does radical resection improve outcome

Polypoid lesions of the gallbladder: Report of 100 cases with special reference to operative indications

In 200 consecutive cholecystectomy specimens excised for cholelithiasis or cholecystitis, 83% exhibited epithelial hyperplasia, 13.5%, atypical hyperplasia and 3.5%, carcinoma in situ. Carcinoma in situ was also observed in the mucosa adjacent to invasive carcinomas in 79% of 39 evaluable surgical cases and in 52.9% of 17 autopsy cases. Our findings suggest that a small number of hyperplasias of the gallbladder evolve toward atypical hyperplasia and that this progresses to in situ carcinoma which finally becomes invasive carcinoma. A simple cytologic technique is recommended for the diagnosis of atypical hyperplasia and carcinoma in situ in excised gallbladders. Preoperative identification of these two lesions in high-risk patients as well as comments on 156 invasive carcinomas are presented.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819800301%2945%3A5%3C919%3A%3AAID-CNCR2820450514%3E3.0.CO%3B2-4

The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ

How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy

Background:

This study was designed to address whether gallbladder cancer invading the muscle layer (stage pT1b) is a local disease and whether radical resection is necessary.



Methods:

A retrospective analysis of 25 patients with pT1b gallbladder tumours, 13 of whom underwent simple cholecystectomy and 12 radical resection with regional lymph node dissection, was performed. A total of 147 regional lymph nodes was examined for metastasis. The median follow-up time was 95 months.



Results:

No patient had blood vessel or perineural invasion on histology. Lymphatic vessel invasion was seen in one patient. Both overt metastasis and micrometastases were absent in all lymph nodes examined. Overall 10-year survival was 87 per cent. The outcome after simple cholecystectomy was comparable to that after radical resection (P = 0.16). Two patients who underwent radical resection died from tumour relapse in distant sites.



Conclusion:

Most pT1b gallbladder carcinomas spread only locally. Additional radical resection is not necessary when the depth of invasion of gallbladder carcinoma is limited to the muscle layer after simple cholecystectomy. © 2001 British Journal of Surgery Society Ltd

Early gallbladder carcinoma does not warrant radical resection

The prognosis for advanced carcinoma of the gallbladder is grave, but a reappraisal of the histologic and gross presentation of the disease may uncover a group of patients with significantly better prognosis. During any cholecystedtomy, the gallbladder should be opened by the surgeon and frozen sections should be obtained for suspicious lesions. Carcinoma in situ appears to be well treated by cholecstectomy alone. Microinvasive carcinomas of the gallbladder require wider surgical excision

Carcinoma in situ of the gallbladder: A dilemma.

In summary, we have reviewed 914 patients who underwent primary biliary procedures at the University of Kentucky between 1962-1970. Twenty-one (2.5%) of these patients were found to have carcinoma of the gallbladder. There were differences in histological evidence of invasion and in survival between invasive, microinvasive and in situ carcinomas. The changing age of the population and the increasing incidence of cholelithiasis make it likely that the incidence of carcinoma of the gallbladder will also increase. Today, aggressive surgical therapy will probably not change the prognosis for invasive carcinoma.

Importance of histologic classification of carcinoma of the gallbladder.

An analysis of 944 cases of acute appendicitis treated at the University of Kentucky Medical Center from 1966 to 1973 is presented. There were 12 deaths in this series, a mortality rate of 1.3 per cent, and the clinical presentation, operative and autopsy findings are discussed. It is significant that seven of the 12 patients had other serious illnesses that influenced the decision for operation and that operation was delayed over 48 hours in 50 percent. It is stressed that the need for early exploration in the patient suspected of having appendicitis is even more imperative in the individual with concomitant disease. Adequate but immediate preoperative preparation with fluids and electrolytes antibiotics and stabilization of renal, pulmonary and cardiac status is mandatory.

Bivins Ba

Papers

Carcinoma in situ of the gallbladder: A dilemma.

Importance of histologic classification of carcinoma of the gallbladder.

Analysis of the causes of mortality from appendicitis.