Diagnosis And Treatment Of Primary Carcinoma Of Gallbladder In 186 Cases

Because there is no special symptom and physical signs of primary gallbladder carcinoma, it is difficult to diagnose in early stage. Most of the patients of primary gallbladder carcinoma had been in middle or late stage when they came to the hospital. So the resection rate is low and the prognosis is dismal. It is reported that the 5 years survival rate of gallbladder carcinoma is less than 5%. The purpose of this study is to summarize the experiences in the diagnosis and treatment of primary gallbladder carcinoma in order to improve its prognosis.Materials and MethodsThe clinical records of 186 cases of primary gallbladder carcinoma in Sir Run Run Shaw hospital from 1994-2004 were retrospectively reviewed, including clinical manifestation, laboratory examination, operative procedure,pathological diagnosis, morbidity and mortality, and follow up result. Diagnosis analysis was assessed by the Long-Rank test. All statistical analysis was carried out on SPSS 11.5 version for Windows.ResultsThere were 68 males and 118 females patients, with M:F=1:1. 74, the age ranged from 31 to 89 years old with a mean of 63.86. Right upper quadrant pain, jaundice and abdominal distension were their major clinical manifestations. Of 186 patients with PCG, 15 cases (8.1%) were early-stage. The diagnostic rate by ultrasonography was 49. 2%, and that of CT was 71. 3%. 153 patients were operated with a resection rate of 79. 7%, and 81 cases (52.9%) received radical resection. Pathological diagnosis included mostly adenocarcinoma, malignancy of adenoma and adeno-squamous carcinoma. Pathological differentiation of adenocarcinoma: 16 cases of well differentiation, 43 cases of middle differentiation, 42 cases of poor differentiation and 25 cases of unknown. Nevin stage: 10 cases(6. 5%) of Nevin I stage, 5 cases(3. 3%) of Nevin II stage, 31 cases(20. 3%) of Nevin III stage, 5 cases(3. 3%) of Nevin IV stage and 102 cases(66.7%) of Nevin V stage. 154 cases were follow-up with a follow-up rate of 82. 58%. The l-> 3- and 5-year survival rate in radical group was 68.42%> 59.879k 31.93% respectively, which was remarkably higher than the palliativegroup.ConclusionsEarly diagnosis and radical resection are still the mainstay for long-term survival of the patients with primary gallbladder carcinoma. However, most cases in clinic were diagnosed at middle or late stage. Active surgical procedure should be attempted for local advanced PCG, which would helpful to prolong the survival time. The patients with unexpected gallbladder carcinoma discovered during or after laparoscopic cholecystectomy had a higher incidence of incision implantation, and we should pay more attention to this problem.