Early Gallbladder Cancer: Clinical, Morphological, Therapeutic and Evolutionary Aspects

Berkane Salah, Abid Larbi

Unit of Visceral and Oncological Surgery, Bologhine Hospital, Algiers, Algeria.

DOI: 10.4236/ss.2013.411095                

Abstract

Introduction: The early cancer of gallbladder is an entity which is not well recognized currently. It is a cancer which does not extend beyond the muscularis layer of the gallbladder and it is characterized in almost of cases by the absence of lymph node and visceral invasion. Patients and Method: We have conducted this retrospective study of all our cases of early gallbladder cancer treated in our surgical unit. We have studied these through clinical, morphological, therapeutical and evolutionary aspects. Results: Of 202 gallbladder carcinoma, 33 cancers were classified as early cancer. 25 were females and 8 were males. The mean age was 56.4 years (41 - 70 years). All patients were free of gallbladder cancer symptoms and all except one had normal CEA and CA19.9. 2 patients had synchronous tumors (one colonic cancer and one rectal cancer). For 16 patients, the diagnosis was done by ultrasonography and 17 by histological examination of the specimen removed for biliary lithiasis. 8 patients had PT1a tumor (confined only to mucosa) and 25 had PT1b tumor (tumor infiltration of the muscular layer). For 19 patients who benefited from extensive lymphadenectomy, only one (5.3%) had lymph node infiltration. 16 patients had a simple cholecystectomy and in two cases, the cholecystectomy was associated with bile duct resection. 17 patients had hepatectomy with extensive lymphadenectomy. 2 patients had a simultaneous right colectomy and abdominoperineal resection and another one benefited from choledocal cyst resection. 3 patients benefited from stone removal from bile duct and two had tumor removal from bile duct (ruptured tumor in the bile duct). 1 patient (3.7%) died in postoperative course (hospital mortality). In the follow-up period, 4 patients died from intercurrent causes. Two patients presented a recurrence at 14 and 36 months and died respectively at 19 and 42 months. One patient presented a bile duct cancer at 66 months. She died at 78 months after palliative treatment. Currently, 22 patients (66.7%) are still alive without recurrence with mean and median survival of 53 and 31 months. Conclusion: Early gallbladder cancer is an entity which must be known by the radiologist and the surgeon. Recognized on time and well treated, early gallbladder cancer can be cured and its prognosis is excellent.

Keywords

Early Cancer; Gallbladder Cancer; Ultrasonography; Expert Radiologist; Surgical Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. Mizumoto, Y. Ogura and T. Kusuda, “Definition and Diagnostic of Early Cancer of Biliary Tract,” HepatoGastroenyterology, Vol. 40, No. 1, 1993, pp. 69-77.
[2]	A. Koga, S. Yamaguchi, Y. Izumi and N. Hamanaka, “Ultrasonographic Detection of Early and Curable Carcinoma of the Gallbladder,” British Journal of Surgery, Vol. 72, No. 9, 1988, pp. 728-730. http://dx.doi.org/10.1002/bjs.1800720919
[3]	H. Onoyama, M. Yamamoto, M. Takada, T. Urakawa, T. Ajiki, I. Yamada, T. Fujita and Y. Saitoh, “Diagnostic Imaging of Early Gallbladder Cancer: Retrospective Study of 53 Cases,” World Journal of Surgery, Vol. 23, No. 7, 1999, pp. 708-712. http://dx.doi.org/10.1007/PL00012373
[4]	K. Ouchi, M. Suzuki, S. Saijo, K. Ito and S. Matsuno, “Do Recent Advances in Diagnosis and Operative Management Improve the Outcome of Gallbladder Carcinoma,” Surgery, Vol. 113, 1993, pp. 324-329.
[5]	Y. Tsuchiya, “Early Carcinoma of the Gallbladder: Macroscopic Features and Us Findings,” Radiology, Vol. 179, No. 1, 1991, pp. 171-175.
[6]	O. Glehen, O. Czyglik, A. D. V. Donsbeck, S. Isaak, F. N. Gilly, Y. Fran?ois and J. Vignal, “Cancers Vésiculaires de Découverte Fortuite,” Annales de Chirurgie, Vol. 125, No. 2, 2000, pp. 137-143. http://dx.doi.org/10.1016/S0001-4001(00)00114-8
[7]	E. Kraas, D. Frauenschuh and S. Farke, “Intraoperative Suspicion of Gallbladder Carcinoma in Laparoscopic Surgery: What to Do?” Digestive Surgery, Vol. 19, No. 6, 2002, pp. 489-493. http://dx.doi.org/10.1159/000067602
[8]	Y. Shirai, K. Yoshida, K. Tsukada and T. Muto, “Unapparent Carcinoma of the Gallbladder,” Annals of Surgery, Vol. 215, 1992, pp. 326-331. http://dx.doi.org/10.1097/00000658-199204000-00004
[9]	F. Iida, S. Kajikawa and N. Horigone, “Evaluation of Imaging Examination for Hepatic Invasion of Carcinoma of the Gallbladder and Post Operative Outcome,” Journal of the American College of Surgeons, Vol. 180, No. 1, 1995, pp. 72-76.
[10]	T. Azuma, T. Yoshikawa, T. Araida and K. Takasaki, “Differential Diagnosis of Polypoid Lesions of the Gallbladder by Endoscopic Ultrasonography,” American Journal of Surgery, Vol. 181, No. 1, 2001, pp. 65-70. http://dx.doi.org/10.1016/S0002-9610(00)00526-2
[11]	R. M. Appleman, C. G. Morlock, D. C. Dahlin and M. A. Adson, “Long Term Survival in Carcinoma of the Gallbladder,” Surgical, Gynecology and Obstetric, Vol. 117, 1963, pp. 459-464.
[12]	X. de Aretxabala, I. Roa, L. Burgos, J. C. Araya, L. Fonseca, I. Wistuba and P. Flores, “Gallblader Cancer in Chile. A Report on 54 Potentially Resectable Tumors,” Cancer, Vol. 69, No. 1, 1992, pp. 60-65. http://dx.doi.org/10.1002/1097-0142(19920101)69:1<60::AID-CNCR2820690112>3.0.CO;2-N
[13]	H. Isman and M. Brisard, “L’espoir de Guérison du Cancer de la Vésicule Biliaire. Arguments Pour une Conception Nouvelle des Stades Précoces,” Journal de Chirurgie, Vol. 121, No. 1, 1984, pp. 51-55.
[14]	Y. Ogura, R. Mizumoto, S. Isaji, T. Kusuda, S. Matsuda and M. Tabata, “Radical Operations for Carcinoma of the Gallbladder: Present Status in Japan,” World Journal of Surgery, Vol. 15, No. 3, 1991, pp. 337-343. http://dx.doi.org/10.1007/BF01658725
[15]	K. Ouchi, M. Suzuki, T. Tominaga, S. Saijo and S. Matsuno, “Survival after Surgery for Cancer of the Gallbladder,” British Journal of Surgery, Vol. 81, No. 11, 1994, pp. 16655-1657. http://dx.doi.org/ 10.1002/bjs.1800811131
[16]	T. Wakai, Y. Shirai, N. Yokoyama, S. Nagakura, H. Watanabe and K. Hatakeyama, “Early Gallbladder Carcinoma Does Not Warrant Radical Resection,” British Journal of Surgery, Vol. 88, No. 5, 2001, pp. 675-678. http://dx.doi.org/10.1046/j.1365-2168.2001.01749.x
[17]	M. Yamamoto, H. Onoyama, T. Ajiki, I. Yamada, T. Fujita and Y. Saitoh, “Surgical Results of Operation for Carcinoma of the Gallbladder,” Hepato-Gastroenterology, Vol. 46, No. 27, 1999, pp. 1552-1556.
[18]	K. Yamaguchi and M. Tsuneoshi, “Subclinical Gallbladder Carcinoma,” American Journal of Surgery, Vol. 163, No. 4, 1992, pp. 382-386. http://dx.doi.org/10.1016/0002-9610(92)90038-S
[19]	K. Yamaguchi, K. Chijiiwa, S. Saiki, K. Nishihara, M. Takashima, K. Kawakami and M. Tanaka, “Retrospective Analysis of 70 Operations for Gallbladder Carcinoma,” British Journal of Surgery, Vol. 84, No. 2, 1997, pp. 200-204. http://dx.doi.org/10.1002/bjs.1800840217
[20]	H. Kinoshita, K. Hashiro, M. Hashimoto, T. Kodama, K. Nishimura, M. Kawataba, S. Furukawa, T. Tamae, J. Nagashima, M. Hara, H. Imayama and S. Aoyagi, “Clinicopathological Evaluation of Surgical Treatment for Early Gallbladder Cancer,” Kurume Medical Journal, Vol. 48, No. 4, 2001, pp. 267-271. http://dx.doi.org/10.2739/kurumemedj.48.267
[21]	G. Wagholikar, D. Gajanan, A. Behari, N. Krishnani, A. Kumar, S. S. Sadiq, R. Saxena and V. K. Kapoor, “Early Gallbladder Carcinoma,” Journal of the American College of Surgeons, Vol. 194, No. 5, 2002, pp. 137-141. http://dx.doi.org/10.1016/S1072-7515(01)01136-X
[22]	E. Yildrim, O. Celen, K. Gulben and U. Berberuglu, “The Surgical Management of Incidental Gallbladder Carcinoma,” European Journal of Surgery, Vol. 31, No. 1, 2005, pp. 45-52.
[23]	T. Shimizu, Y. Arima, S. Yokomuro, H. Yoshida, Y. Mamada, T. Numura, N. Taniai, T. Aimoto, Y. Nakamura, Y. Mizuguchi, Y. Kawahigashi, E. Uchida, K. Akimaru and T. Tajiri, “Incidental Gallbladder Cancer Diagnosed during and after Laparoscopic Cholecystectomy,” Journal of Nippon Medical School, Vol. 73, 2006, pp. 136-140.
[24]	P. J. Shukla, G. Barreto, A. Karade and S. V. Shrikhande, “Revision Surgery for Incidental Gallbladder: Factors Influencing Operability and Further Evidence for pT1b Tumors,” HPB, Vol. 10, No. 1, 2008, pp. 43-47. http://dx.doi.org/10.1080/13651820701867794
[25]	M. A. Abramson, P. Pandharipande, D. Ruan, J. S. Gold and E. E. Whang, “Radical Resection for pT1b Cancer: A Decision Analysis,” HPB, Vol. 11, No. 8, 2009, pp. 656-663. http://dx.doi.org/10.1111/j. 1477-2574.2009.00108.x
[26]	D. M. Hari, J. H. Howard, A. M. Leung, C. G. Chui, M. S. Sim and A. J. Bilchik, “A 21-Year Analysis of Stage I Gallbladder Carcinoma: Is Cholecystectomy Alone Adequate?” HPB, Vol. 15, No. 1, 2013, pp. 40-48. http://dx.doi.org/10.1111/j.1477-2574.2012.00559.x