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Cancer Types / Gastrointestinal Cancers / Gallbladder Cancer / NCI Resources

NCI CANCERLIT^® Search: Bile Duct and Gallbladder Cancer - March 2002

National Cancer Institute^®
Last Modified: March 1, 2002

Cholangiographic findings of early-stage extrahepatic bile duct carcinoma.

Prognostic role of angiogenesis in operable carcinoma of the gallbladder.

Incidental carcinoma of the gallbladder.

Extensive surgery for carcinoma of the gallbladder.

Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: are they necessary and safe procedures?

Staging of pancreatic and ampullary cancers for resectability using laparoscopy with laparoscopic ultrasound.

Periampullary tumors. Analysis of 319 consecutive cases submitted to preoperative endoscopic biliary drainage.

Table of Contents

1
UI - 11777212
AU - Tamada K; Tomiyama T; Wada S; Ohashi A; Satoh Y; Ido K; Sugano K
TI - Cholangiographic findings of early-stage extrahepatic bile duct carcinoma.
SO - J Gastroenterol 2001 Dec;36(12):837-41
AD - Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
BACKGROUND: To clarify the cholangiographic findings of early-stage (T1, tumor confined to the mucosal or fibromuscular layer) extrahepatic bile duct carcinoma. METHODS: Cholangiographic images were retrospectively analyzed without other information in 55 patients with extrahepatic bile duct carcinoma who underwent surgical treatment. Tumor stages were T1 (n = 10). T2 (n = 17), and T3 (n = 28). Cholangiographic findings were classified as "diffuse sclerosis," "stenosis," "papillary polypoid filling defect," or "nodular polypoid filling defect". "Papillary polypoid filling defect" was the term used when the width of the base was smaller than the width of the polypoid filling defect. RESULTS: T1 patients showed papillary polypoid filling defects (n = 8) or nodular polypoid filling defects (n = 2) on cholangiography. When cholangiography showed papillary polypoid filling defects, 8 of the 14 resected patients showed T1 stage tumor histologically. CONCLUSIONS: In this study, 57% (8/14) of resected patients with papillary polypoid filling defects showed T1 stage tumor. No T1 stage tumor showed stenosis or diffuse sclerosis.

2
UI - 11823693
AU - Giatromanolaki A; Sivridis E; Koukourakis MI; Polychronidis A;
TI - Simopoulos C Prognostic role of angiogenesis in operable carcinoma of the gallbladder.
SO - Am J Clin Oncol 2002 Feb;25(1):38-41
AD - Department of Pathology, Democritus University of Thrace, General Hospital Alexandroupolis, P.O. Box 12, Alexandroupolis 68100, Greece.
The prognostic significance of intratumoral angiogenesis was investigated in 62 patients with stage I-III carcinomas of the gallbladder treated with simple cholecystectomy. Microvessel density (MVD) was assessed immunohistochemically, using the alkaline phosphatase/anti-alkaline phosphatase method and the monoclonal antibody CD31. The mean MVD was 30.5 vessels per x 200 optical field. Using the thirty-third and the sixty-sixth percentile, the patients were grouped into three MVD categories: low (MVD 9-18; 20 patients), medium (MVD 19-31; 20 patients), and high (MVD 32-86; 22 patients). A high MVD was more frequent in well-differentiated adenocarcinomas compared with moderately and poorly differentiated tumors (p = 0.04), but there was no statistically significant association between MVD and T stage, or patients' age or sex. Multivariate analysis, including MVD, T stage, and histologic grade, showed that MVD was a significant independent prognostic factor in carcinomas of the gallbladder (p = 0.001, t ratio 3.3). It is believed that the assessment of intratumoral angiogenesis in patients with operable gallbladder carcinomas may be useful in predicting prognosis and, perhaps, in decision making for postoperative adjuvant treatment.

3
UI - 11869005
AU - Varshney S; Buttirini G; Gupta R
TI - Incidental carcinoma of the gallbladder.
SO - Eur J Surg Oncol 2002 Feb;28(1):4-10
AD - Surgical Gastroenterology, Bhopal Memorial Hospital, Bhopal, India. varshney@bom6.vsnl.net.in
Incidental gallbladder carcinoma (GBC) is a difficult management issue as there are no established guidelines. Laparoscopic cholecystectomy is associated with increased dissemination of the tumour cells (both in the peritoneal cavity and port sites). Depth of tumour invasion (T stage) and positive surgical margins are the most important prognostic factors, although tumour differentiation, lymphatic, perineural and vascular invasion may also affect the outcome. Simple cholecystectomy is adequate for mucosal (T1a) lesions only. For T1b tumours port site/wound excision with second radical operation (probably extended cholecystectomy -- wedge liver excision with regional lymphadenectomy) should be advised. T2 tumours should be treated with second radical operation (extended cholecystectomy or excision of medial liver segments 4b and 5 or 4, 5 and 8 with regional lymphadenectomy with or without excision of the extra-hepatic bile duct). Few T3 tumours can be cured and in some survival time may be prolonged by a second radical operation. More extensive liver resection (segments 4b and 5 or segments 4, 5 and 8) with regional lymphadenectomy with excision of the extra-hepatic bile duct should be advised. A second radical operation may palliate some T4 tumours. In the absence of extensive nodal disease, this operation may prolong the survival time. Excision of the extra-hepatic bile duct should be undertaken whenever the tumour involves the cystic duct margin or the extra-hepatic biliary tree. Epidemiology, risk factors, aetiopathogenesis and the modes of spread of GBC are discussed in relation to appropriateness of the second radical operation. Indications, types and role of the second radical operation are discussed. Copyright Harcourt Publishers Limited.

4
UI - 11856130
AU - Kondo S; Nimura Y; Hayakawa N; Kamiya J; Nagino M; Uesaka K
TI - Extensive surgery for carcinoma of the gallbladder.
SO - Br J Surg 2002 Feb;89(2):179-84
AD - First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
BACKGROUND: The purpose of this study was to clarify the efficacy of, and define the indications for, extensive surgery for gallbladder carcinoma. METHODS: Between 1979 and 1994, 116 patients with gallbladder carcinoma underwent operation. Radical resection was performed in 80 patients. RESULTS: In 68 patients with stage III or IV disease, extensive resection including extended right hepatectomy (n = 40), pancreaticoduodenectomy (n = 23) and/or portal vein resection (n = 23) was employed to achieve complete tumour excision. The hospital mortality rate was 18 per cent. The postoperative 3- and 5-year survival rates were 44 and 33 per cent respectively in the patients with stage III disease (n = 9), and 24 and 17 per cent respectively in patients with stage IV (M0) disease (n = 29). In contrast, the postoperative survival rate for the 30 patients with stage IV (M1) disease (7 per cent at 3 years and 3 per cent at 5 years) was worse than that for patients with stage III and stage IV (M0) disease (P = 0.009 and P = 0.062 respectively). CONCLUSION: Radical resection should be undertaken for stage III and stage IV (M0) gallbladder cancer. Although portal vein resection and/or pancreaticoduodenectomy did not contribute to long-term survival, better survival was obtained than that for the unresected patients.

5
UI - 11818948
AU - Lee SK; Kim MH; Seo DW; Lee SS; Park JS
TI - Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: are they necessary and safe procedures?
SO - Gastrointest Endosc 2002 Feb;55(2):302-4

6
UI - 11727085
AU - Menack MJ; Spitz JD; Arregui ME
TI - Staging of pancreatic and ampullary cancers for resectability using laparoscopy with laparoscopic ultrasound.
SO - Surg Endosc 2001 Oct;15(10):1129-34
AD - Division of Surgery, New York United Hospital Medical Center, 406 Boston Post Road, Port Chester, NY 10573, USA.
BACKGROUND: Cancers of the pancreas and periampullary region are rarely curable. We set out to determine the efficacy of laparoscopy with laparoscopic ultrasound in the staging of pancreatic and ampullary (LS) of tumors already deemed resectable by standard radiologic criteria in 27 patients using laparoscopy with laparoscopic ultrasound (LUS). Patients found to be resectable by LS evaluation underwent laparotomy (LA). We then compared the results of the LS and LA findings. RESULTS: Of the 27 patients evaluated, 17 were men and 10 were women. Their mean age was 66 years. Preoperative computerized tomography (CT) scans were done in all 27 patients (100%), and transabdominal and endoscopic ultrasound (EUS) was done in 21 (78%). By LS, seven patients (26%) were found to have unresectable disease. Two patients with mesenteric tumor infiltration (one with peritoneal implants, and one with a visible liver metastasis) were judged to be unresectable by laparoscopy alone. LUS revealed that one patient had portal vein (PV) occlusion and two had metastases to the lymph nodes or liver that were not revealed by preoperative studies or laparoscopy alone. Among 20 patients (74%) deemed resectable by LS, two (10%) were found to be unresectable at LA, one due to PV involvement and the other due to local tumor extension with superior mesenteric lymph node metastasis. Eighteen of those in whom resection was attempted (90%) were resectable, with no unexpected findings of distant lymph node or hepatic metastasis. Pathology examination showed that eight had regional metastases (44%). The sensitivity of LS in determining unresectability was 77% (seven true positives and two false negatives). The negative predictive value (reflecting resectability) was 90%. Laparoscopy alone had a sensitivity of 44%, with a negative predictive value of 78%. The sensitivity and positive predictive value of LS was 100%, reflecting no false positive examinations. CONCLUSIONS: LS can effectively stage most patients and reliably predict which of them will benefit from LA. Intervention for unresectable patients can then be limited to laparoscopic or endoscopic bypass. The main limitation is that LS may underestimate PV and regional lymph node involvement.

7
UI - 11727086
AU - Coppola R; Riccioni ME; Ciletti S; Cosentino L; Ripetti V; Magistrelli
TI - P; Picciocchi A Periampullary tumors. Analysis of 319 consecutive cases submitted to preoperative endoscopic biliary drainage.
SO - Surg Endosc 2001 Oct;15(10):1135-9
AD - Department of General Surgery, Catholic University School of Medicine, Largo A. Gemelli, 8-00168 Rome, Italy.
BACKGROUND: During the last 2 decades, endoscopic retrograde cholangiopancreatography (ERCP) has been widely used for the diagnosis of periampullary tumors and the preoperative or definitive treatment of jaundice. METHODS: We performed a retrospective analysis of 319 consecutive patients (184 men and 135 women with an average age of 66.5 years) who underwent ERCP for periampullary tumors between 1987 and 1999. RESULTS: Endoscopic internal biliary drainage was successful in 293 patients (92%), with some differences due to the origin of the tumor. There were five complications (1.5%), including four bleeds and one retroduodenal perforation. There were no deaths related to the endoscopic drainage. Eighty-four patients underwent pancreaticoduodenectomy. The postoperative morbidity rate was 23%, and the overall mortality rate was 4.8%. CONCLUSION: ERCP is a valid technique for the detailed preoperative assessment of periampullary tumors. It is also a safe method for internal biliary drainage.

The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.

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