Which Case of Preoperative Suspected Gallbladder Cancer Is Most Appropriate for Laparoscopic Cholecystectomy ?

BACKGROUND/PURPOSE: The surgical procedure for gallbladder cancer is still difficult to improve a prognosis. Otherwise, laparoscopic cholecystectomy (LC) is possible to get complete cure in some cases of early cancer. The present study aims to clarify the appropriate case for LC by evaluating the preoperative suspected gallbladder cancer and its clinicopathological finding. METHODS: We performed a retrospective analysis of patients with gallbladder cancer who underwent cholecystectomy from 1981 to 2007 at Kitasato university east hospital in Japan. The histopathological finding clarified the horizontal carcinomatous spread and invasion depth in the 53 cases precisely. We classified those macroscopic configuration and the characteristic. Long-term survival was calculated using the Kaplan-Meier method, and differences in group of survivors were compared by the log-rank test. RESULT: 43 cases of protruding lesion and 10 cases of wall thickness and flat invasive lesion (WT) were defined. The protruding lesions were classified into 3 subclass, such as pedicle type (PD, n=7), nodular type (ND, n=25) and papillary type (PP, n=11). ND and PP were sessile lesions. Particularly, the cancer nest was localized in the basal point with PD. On the other hand, the size of cancer spread in ND, PP, WT were 5.8}3.5~4.0}2.0, 4.8}2.8~4.0}1.9, 5.6}2.6~5.1}2.6 (cm), respectively. These sizes of spreading part were 3 to 6 times of the protruding part. The frequency of case beyond pT2 cancer was 0% (PD), 91% (ND), 82.8% (PP), 90% (WT). Patients with pT1 tumor who underwent no additional surgery, are alive without recurrence. In patients with pT2 cancer, the 5-year survival rate was 52.6%. Furthermore, those with pT3 lesions had poor prognoses (MST; 12 months). CONCLUSION: Also the regional lymphadenectomy is necessary for the cases of pT2 cancer. There is much frequency of advanced cancer with sessile lesion and flat lesion. However, all cases with macroscopic pedicle type were pT1 cancer. Thus, the case with pedicle lesion is optimal for the laparoscopic cholecystectomy.

Session: Poster

Program Number: P421

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