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

An analysis of the role of radiotherapy in the management of gallbladder (GB) and extra-hepatic bile duct (EHBD) cancer its based upon thirteen patients irradiated in our hospital and a review of the literature. These patients were treated as part of curative or palliative management in conjunction with surgery, after surgical failure or recurrence, and as the only palliative modality. Doses ranged from 3800 to 7225 rad. Significant palliation was obtained in 92% of the patients; average total bilirubin value decreased from 9.1 mg.% before to 1.7 mg.% after radiotherapy. The mean survival of all patients was 12.7 months after surgery (7.1 in GB, 16.1 in EHBD), and was 7.3 months after initiation of radiotherapy (6.3 in GB, 8.0 in EHBD). Two patients were alive and well with no evidence of disease 12 and 16 months after radiotherapy, and local tumor control was achieved in two. Complications included possible biliary fibrosis. Based upon a critical review of the surgical, chemotherapeutic, and radiotherapeutic literature, it is concluded that present surgical therapy fails because of extensive regional disease in which local recurrences follow various simple and radical surgical maneuvers; palliative surgery often fails. Survival rates have been poor following any therapy at present, although encouraging results are seen with carefully planned megavoltage radiotherapy. A proposal its made to evaluate the role of radiotherapy systematically: as part of curative therapy post-operatively to decrease local recurrences and to increase the length and quality of survival; to treat incisional recurrences; as part of advanced disease management to increase the effectiveness and length of palliation; and in conjunction with chemotherapy to further consolidate therapeutic gains made with radiotherapy alone.

The role of radiation therapy in cancer of the extra-hepatic biliary system: an analysis of thirteen patients and a review of the literature of the effectiveness of surgery, chemotherapy and radiotherapy?

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

Weiss Dl

Papers

Carcinoma in situ of the gallbladder: A dilemma.