National Cancer Institute®
Last Modified: May 1, 2002
UI - 10235519
AU - Yeo CJ; Cameron JL; Sohn TA; Coleman J; Sauter PK; Hruban RH; Pitt HA;
TI - Lillemoe KD Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome.
SO - Ann Surg 1999 May;229(5):613-22; discussion 622-4
AD - Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
OBJECTIVE: This prospective, randomized, single-institution trial was designed to evaluate the end points of mortality, morbidity, and survival in patients undergoing standard versus radical (extended) pancreaticoduodenectomy (including distal gastrectomy and retroperitoneal lymphadenectomy). SUMMARY BACKGROUND DATA: Numerous retrospective reports and one prospective randomized trial have suggested that the performance of an extended lymphadenectomy in association with a pancreaticoduodenal resection may improve long-term survival for some patients with pancreatic and other periampullary adenocarcinomas. Many of these previously published studies can be criticized for their retrospective and nonrandomized designs, for the inclusion of nonconcurrent control groups, and for their small numbers. periampullary adenocarcinoma were enrolled in an ongoing, prospective, randomized trial at The Johns Hopkins Hospital. After intraoperative verification of completely resected periampullary adenocarcinoma, the patients were randomized to receive either a standard pancreaticoduodenectomy (removing only the peripancreatic lymph nodes en bloc with the specimen) or a radical pancreaticoduodenectomy (standard resection plus distal gastrectomy and retroperitoneal lymphadenectomy). All pathology specimens were reviewed and categorized. The postoperative morbidity, mortality, and short-term outcomes were examined. RESULTS: Of the 114 patients randomized, 56 underwent a standard pancreaticoduodenectomy and 58 a radical pancreaticoduodenectomy. The two groups were statistically similar with regard to age and gender, but there was a higher percentage of white patients in the radical group. All the patients in the radical group underwent distal gastric resection, whereas 86% of the patients in the standard group underwent pylorus preservation. The mean operative time in the radical group was 6.8 hours, compared with 6.2 hours in the standard group. There were no significant differences between the two groups with respect to the intraoperative blood loss, transfusion requirements, location of primary tumor, mean tumor size, positive lymph node status, or positive margin status. There were three deaths in the standard group and two in the radical group. The complication rates were 34% for the standard group and 40% for the radical group. Patients undergoing radical resection had a higher incidence of early delayed gastric emptying but had similar rates of other complications, such as pancreatic fistula, wound infection, intraabdominal abscess, and need for reoperation. The mean total number of lymph nodes resected was higher in the radical group. Of the 58 patients in the radical group, only 10% had metastatic carcinoma in the resected retroperitoneal lymph nodes, and none of those patients had the retroperitoneal nodes as the only site of lymph node involvement. The 1-year actuarial survival rate for patients surviving the immediate postoperative periods was 77% for the standard resection group and 83% for the radical resection group. CONCLUSIONS: These data demonstrate that radical pancreaticoduodenectomy (with the addition of a distal gastrectomy and extended retroperitoneal lymphadenectomy to a standard pancreaticoduodenectomy) can be performed with similar morbidity and mortality to standard pancreaticoduodenectomy. However, the survival data are not sufficiently mature and the numbers of patients enrolled are not adequate to allow firm conclusions to be drawn regarding survival benefit.
UI - 11259693
AU - Levy AD; Murakata LA; Rohrmann CA Jr
TI - Gallbladder carcinoma: radiologic-pathologic correlation.
SO - Radiographics 2001 Mar-Apr;21(2):295-314; questionnaire, 549-55
AD - Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA. email@example.com
Primary carcinoma of the gallbladder is an uncommon, aggressive malignancy that affects women more frequently than men. Older age groups are most often affected, and coexisting gallstones are present in the vast majority of cases. The symptoms at presentation are vague and are most often related to adjacent organ invasion. Therefore, despite advances in cross-sectional imaging, early-stage tumors are not often encountered. Imaging studies may reveal a mass replacing the normal gallbladder, diffuse or focal thickening of the gallbladder wall, or a polypoid mass within the gallbladder lumen. Adjacent organ invasion, most commonly involving the liver, is typically present at diagnosis, as is biliary obstruction. Periportal and peripancreatic lymphadenopathy, hematogenous metastases, and peritoneal metastases may also be seen. The vast majority of gallbladder carcinomas are adenocarcinomas. Because most patients present with advanced disease, the prognosis is poor, with a reported 5-year survival rate of less than 5% in most large series. The radiologic differential diagnosis includes the more frequently encountered inflammatory conditions of the gallbladder, xanthogranulomatous cholecystitis, adenomyomatosis, other hepatobiliary malignancies, and metastatic disease.
UI - 11956900
AU - Endo I; Shimada H; Fujii Y; Sugita M; Masunari H; Miura Y; Tanaka K;
TI - Misuta K; Sekido H; Togo S Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasion.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):505-10
AD - Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
PURPOSE: Hepatoduodenal ligament invasion (HLI) is an inhibiting factor for the curative resection of advanced gallbladder cancer. The aim of this study was to clarify the indications for surgical resection in patients with advanced gallbladder cancer with and without HLI by analyzing outcomes. METHODS: The subjects were 58 patients with advanced gallbladder cancer who underwent aggressive resection, and 20 nonresected patients diagnosed as haring HLI. The presence of stromal cancerous infiltration at six sites in the hepatoduodenal ligament was investigated. The extent of cancer spread was classified into two grades by the number of sites where cancer cells detected: low grade, one or two invasion sites; high grade, three or more sites. RESULTS: Pancreatoduodenectomy, vascular reconstruction, and extensive hepatectomy were frequently performed in the patients with HLI. The cumulative 5-year-survival rate of the HLI patients was 10.9%, significantly worse than that of the resected patients without HLI (46.6%; P < 0.01). Patients with paraaortic lymph node metastasis died within 1 year. The cumulative 5-year-survival rate after curative resection was 38.1%, significantly better than that after noncurative resection (0%; P < 0.05). The survival was significantly worse in patients with high-grade invasion than in these with low-grade invasion (P < 0.05), being equivalent to that in the nonresection patients. Of four factors, operative curability, hepatic lobectomy, HLI grade, and paraaortic lymph node metastasis, the HLI grade and hepatic lobectomy were considered to be significant prognostic factors by Cox's multivariate analysis (backward stepwise method). CONCLUSIONS: Aggressive surgical resection for curative purposes should be limited to patients with low-grade HLI and metastasis-negative paraaortic lymph nodes.
UI - 11956901
AU - Kondo S; Nimura Y; Kamiya J; Nagino M; Kanai M; Uesaka K; Yuasa N; Sano
TI - T; Hayakawa N Five-year survivors after aggressive surgery for stage IV gallbladder cancer.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):511-7
AD - First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
PURPOSE: To describe 5-year survivors after radical surgery for stage IV gallbladder cancer and to determine the characteristics leading to potential long-term survival. METHODS: Of 59 patients undergoing radical resection for stage IV disease between 1979 and 1994, 6 patients who have survived for more than 5 years were followed up. RESULTS: Three patients had developed obstructive jaundice due to involvement of the hepatic hilum, but the other three had not. The jaundiced patients had remarkable tumor spread over the bile duct and right hepatic artery within the hepatoduodenal ligament. However, the proper and left hepatic arteries and the portal trunk and its left branch were free from tumor involvement. The nonjaundiced patients had N1 or N2 lymph node metastasis. However, none underwent bile duct resection or pancreatoduodenectomy to establish radical lymphadenectomy. CONCLUSIONS: Selected patients with stage IV gallbladder cancer may be candidates for 5-year survival when the primary tumor is fairly localized even if it forms a large mass and involves neighboring organs including the hepatic duct, lymph node metastasis is limited to N1 and N2 except for the celiac and superior mesenteric nodes and is less infiltrative, and distant metastasis including that in the paraaortic area is absent.
UI - 11956902
AU - Houry S; Barrier A; Huguier M
TI - Irradiation therapy for gallbladder carcinoma: recent advances.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):518-24
AD - Department of Digestive Surgery, Tenon Hospital, University Paris VI, 4 rue de la Chine 75020 Paris, France.
PURPOSE: Gallbladder carcinomas were usually considered to be radioresistant. So far, the role of radiotherapy has not been adequately evaluated. The aim of this report is to assess the value of radiotherapy in carcinoma of the gallbladder. METHODS: We reviewed publications concerning the role of radiation therapy in gallbladder carcinoma from 1974 to 2000. External radiation therapy, intraoperative radiation therapy, and brachytherapy were evaluated in two different groups: one group of patients underwent surgery, with apparently complete resection of the tumor; and another group underwent palliative treatment. RESULTS: Local control of the tumor and reduction of tumor size were reported in several publications. Collected data suggested a slight improvement in survival after adjuvant or palliative radiotherapy. The best benefit was obtained in tumors resected with only microscopic residual tissue. If possible an intraoperative "boost" (15 Gy) is recommended on the gross lesion, residual lesion, or tumor bed. Additional postoperative external radiotherapy (45-50 Gy) must be delivered. CONCLUSION: Radiotherapy appears to be a safe procedure that slightly improves the survival time of patients treated for gallbladder carcinoma. Further trials are needed to assess the role of combined radiotherapy and chemotherapy.
UI - 11956903
AU - Lundberg O; Kristoffersson A
TI - Open versus laparoscopic cholecystectomy for gallbladder carcinoma.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):525-9
AD - Department of Surgery, University Hospital of Northern Sweden, S-901 85, Umea, Sweden.
Laparoscopic surgery has replaced conventional open cholecystectomy for benign gallbladder disease. A major concern is how to handle gallbladder cancer in the laparoscopic era, since there are numerous case reports of port site metastases from gallbladder cancer after laparoscopic cholecystectomy. There are also many experimental studies favoring the opinion that the laparoscopic technique implies a higher risk of spreading malignant disease. This opinion has gained wide acceptance despite little previous clinical effort to determine the risk of tumor dissemination and the lack of comparisons between open and laparoscopic surgery. This report is a short summary of our own studies and present knowledge with special respect to the clinical aspects of the development and incidence of abdominal wall metastases. Among 270 patients with verified gallbladder carcinoma in whom 210 had open surgery and 60 a laparoscopic cholecystectomy, 12 patients (6.5%) in the open cholecystectomy group and 9 (15%) in the laparoscopic group developed incisional metastases. Although the sparse clinical documentation does not unavoidably mean that laparoscopic cholecystectomy has an increased risk of disseminating tumor cells, we recommend open surgery in cases of known or suspected gallbladder carcinoma.
UI - 11956904
AU - Donohue JH
TI - Present status of the diagnosis and treatment of gallbladder carcinoma.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):530-4
AD - Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Because early carcinoma of the gallbladder causes no specific signs or symptoms, most patients with this disease are diagnosed with advanced-stage tumors. High-resolution ultrasonography and a low index of suspicion for polypoid masses or asymmetric gallbladder thickening represent the best method of early detection. Despite regular preoperative gallbladder imaging, many cancers are only detected intraoperatively or incidentally on pathologic examination. All known or suspected gallbladder cancers should be definitively treated with a laparotomy, not laparoscopic surgery. For early gallbladder cancers (Tis and T1 cancers), simple cholecystectomy is adequate therapy. More advanced-stage carcinomas without distant metastases should routinely be managed with a radical cholecystectomy, which includes partial hepatectomy and regional lymphadenectomy. Any adherent organs should be resected en bloc with the cancer. Pancreatoduodenectomy has been performed in several Japanese centers, but is rarely performed in the West for locally advanced gallbladder cancers. Most patients who undergo curative resection will develop recurrent disease, but there is currently no proven effective adjuvant therapy.
UI - 11859717
AU - Qian J; Qin S; He Z
TI - [Arsenic trioxide in the treatment of advanced primary liver and gallbladder cancer]
SO - Zhonghua Zhong Liu Za Zhi 2001 Nov;23(6):487-9
AD - Oncology Center, 81 Hospital, PLA, Nanjing 210002, China.
OBJECTIVE: To evaluate the effect and toxicity of arsenic trioxide (As2O3) in treating primary liver and gallbladder cancer. METHODS: Twenty-nine advanced primary liver cancer and 4 gallbladder cancer patients were treated with As2O3 injection only, 15 mg i.v. qd for 14-21 days and was repeated after 2 weeks. RESULTS: The overall response rate was 15.2%, 13.8% in primary liver cancer (PR 4, NC 21 and PD 4). It was 25.0% in gallbladder cancer (CR 1, NC 2, PD 1). The major side reactions were mild bone marrow suppression and hepatic functional damage. CONCLUSION: As2O3 injection is effective in treating primary liver and gallbladder cancer with mild side reactions. It is worth studying in the future.
UI - 11961639
AU - Aoki T; Tsuchida A; Kasuya K; Inoue K; Saito H; Koyanagi Y
TI - Is frozen section effective for diagnosis of unsuspected gallbladder cancer during laparoscopic cholecystectomy?
SO - Surg Endosc 2002 Jan;16(1):197-200
AD - Department of Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo 160-0023, Japan. firstname.lastname@example.org
BACKGROUND: Although frozen section is recommended to prevent tumor dissemination following laparoscopic cholecystectomy (LC) for unsuspected gallbladder cancer, there are no reports concretely demonstrating its effectiveness and outcome. METHODS: Frozen section during LC was performed in 990 patients with gallstones. The sensitivity, specificity of frozen section, and false-negative cases were evaluated in comparison with postoperative entire cross sections. RESULTS: In frozen section, 983 cases were diagnosed as benign and 7 cases as malignant. Of the benign cases, cancer was discovered in 4 patients postoperatively in which frozen section was diagnosed as regenerative epithelial severe atypia. Sensitivity was 64% and specificity was 100%. Concerning the results of frozen section by p-TNM classification, cancer was diagnosed in 40% of Tis lesions, whereas it was found in 83% of T2 or T3 lesions. CONCLUSION: Frozen section is effective in cases with T2 or greater lesions for which conversion to radical surgery should be required.
UI - 11775430
AU - Pappas SG; Jeruss JS; Talamonti MS
TI - Clinical features of primary and metastatic hepatic malignancies.
SO - Cancer Treat Res 2001;109():1-14
AD - Northwestern University Medical School, Chicago, IL, USA.
UI - 11775433
AU - Dawes LG
TI - Gallbladder cancer.
SO - Cancer Treat Res 2001;109():145-55
AD - University of Michigan, Ann Arbor, MI, USA.
Gallbladder cancer often presents with advanced disease. When found early, surgery can be curative for this particular malignancy. Prognostic factors that influence the success of aggressive surgical therapy include depth of invasion, extent of hepatic infiltration, histologic grade, presence of venous, lymphatic or perineural invasion, and lymph node metastasis. Tumors with tumor limited to the subserosal layer, hepatic infiltration that is only 5 mm or less, papillary or well differentiated adenocarcinomas, tumors with no venous, lymphatic or perineural invasion and lymph node metastasis limited to the hepatoduodenal ligament have the best prognosis with surgery (15, 16, 36). Extended cholecystectomy with lymph node dissection has improved the results of treating T2 gallbladder cancers. More extensive resections should keep the above prognostic factors in mind. When surgical resection is not possible, endoscopic stenting of the biliary tree for palliation of obstructive jaundice is effective. Earlier detection or more effective chemotherapy will be needed to significantly improve the prognosis of this disease.
UI - 11972466
AU - Kim BS; Ha HK; Lee IJ; Kim JH; Eun HW; Bae IY; Kim AY; Kim TK; Kim MH;
TI - Lee SK; Kang W Accuracy of CT in local staging of gallbladder carcinoma.
SO - Acta Radiol 2002 Jan;43(1):71-6
AD - Department of Diagnostic Radiology, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.
PURPOSE: To evaluate the accuracy of CT for staging gallbladder cancers, especially the T-factor of the TNM staging system. MATERIAL AND METHODS: CT investigations of 100 patients with surgically proven gallbladder cancers were retrospectively analyzed. Dynamic helical CT was performed in 16 patients and conventional CT in the remaining 84. On CT, three radiologists attempted tumor staging for these patients; the majority opinion was used for final decision. According to CT protocols (dynamic helical CT vs. conventional CT) and each tumor type (thickened wall/intraluminal mass/massive), the accuracy of CT staging was compared. The CT staging was correlated with the surgico-pathologic results. RESULTS: The overall accuracy of CT for staging gallbladder cancers was 71%; it was 79% for T1 and T2 tumors, 46% for T3 tumors, and 73% for T4 tumors. For all three readers, the poorest accuracy was obtained in T3 tumors. No statistically significant difference was noted in the accuracy between the groups undergoing conventional CT and dynamic helical CT. A statistically significant difference was noted in the accuracy for staging thickened wall and intraluminal mass types of tumors (p<0.05); the highest accuracy was obtained in the intraluminal mass type (89%) and the massive type (83%), while it was 54% in the thickened wall type. CONCLUSION: The accuracy of tumor staging with CT in patients with gallbladder cancer depends on the morphological type of tumor. The poorest result is obtained in the thickened wall type.
UI - 11997831
AU - Wullstein C; Woeste G; Barkhausen S; Gross E; Hopt UT
TI - Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?
SO - Surg Endosc 2002 May;16(5):828-32
AD - Department of General, Thoracic, Vascular, and Transplantation Surgery, University of Rostock, Schillingallee 35, D-18055 Rostock, Germany.
BACKGROUND: Laparoscopy is thought to worsen the prognosis of gallbladder cancer (GBC) discovered unexpectedly at laparoscopic cholecystectomy (LC). However, laproscopy has never been shown to have an influence on patient survival in clinical series. METHODS: We Performed a two-center retrospective analysis of 28 patients with GBC (11 previously known, 17 unexpectedly discovered by LC) to determine whether laparoscopy and complications related to LC had any influence on the prognosis of GBC. Resectability for cure after LC, survival, and recurrence related to both the procedure itself and complications associated with LC were analyzed. RESULTS: Of the 17 patients with unexpected GBC, 16 were considered resectable for cure at the time of LC. Advanced disease was detected in eight patients by re staging (n = 5) or exploration (n = 3). Seven patients (43.8%) underwent reoperation for cure. Mean survival of patients with unexpected GBC was 26.5 months. Mean survival was shorter when complications (bile spillage, injury of common bile duct, or tumor violation) occurred during LC (10.2 vs 33 months, p = 0.016). If bile spillage was the only complication at LC, there was also a trend to shorter survival (12 vs 33 months, p = 0.061). CONCLUSION: Complications during LC significantly worsen the prognosis of GBC. Therefore, bile spillage and excessive manipulation of the gallbladder should be avoided.
UI - 12004989
AU - Baron TH; Fleischer DE
TI - Past, present, and future of endoscopic retrograde cholangiopancreatography: perspectives on the National Institutes of Health consensus conference.
SO - Mayo Clin Proc 2002 May;77(5):407-12
UI - 12004991
AU - Calvo MM; Bujanda L; Calderon A; Heras I; Cabriada JL; Bernal A; Orive
TI - V; Capelastegi A Role of magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis.
SO - Mayo Clin Proc 2002 May;77(5):422-8
AD - Department of Gastroenterology, Galdakao Hospital, Spain.
OBJECTIVES: To investigate the diagnostic efficacy of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis and to determine whether use of MRCP may eliminate the need for purely diagnostic endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: A total of 116 patients with suspected biliopancreatic 1998. Choledocholithiasis was initially suspected in 61 patients and rated before ERCP and MRCP as being of low, intermediate, or high probability based on clinical, laboratory, and/or imaging findings (Cotton criteria). RESULTS: The sensitivity of choledocholithiasis diagnosis was 91%, with a global efficacy of 90%. The level of duct stone obstruction was visualized in all patients. Suprastenotic dilatation also showed a good correlation to ERCP. Choledocholithiasis was found in 32 patients (65%) and 3 patients (33%) in the high- and intermediate-probability groups, respectively. None of the low-probability patients had choledocholithiasis. Endoscopic retrograde cholangiopancreatography was performed for only a diagnostic (not therapeutic) purpose in 3 patients (6%) and 2 patients (22%) of the high- and intermediate-probability cases, respectively. CONCLUSIONS: Magnetic resonance cholangiopancreatography seems to be effective in diagnosing choledocholithiasis. It plays a fundamental role in patients with a low or intermediate risk of choledocholithiasis, contributing to the avoidance of purely diagnostic ERCP.
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