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Abramson Cancer CenterNCI CANCERLIT® Search: Bile Duct and Gallbladder Cancer - September 2002
National Cancer Institute®
Last Modified: September 1, 2002
- Radical second resection provides survival benefit for patients with T2 gallbladder carcinoma first discovered after laparoscopic
- Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: a prospective study of 592 cases.
- Magnetic resonance cholangiopancreatography-guided unilateral endoscopic stent placement for Klatskin tumors.
- Incidental gallbladder cancer.
- High resolution chromosome 3p, 8p, 9q and 22q allelotyping analysis in the pathogenesis of gallbladder carcinoma.
- Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients.
- Allelotype analysis of the PTEN, Smad4 and DCC genes in biliary tract cancer.
- Prognostic significance of S100A4 expression in gallbladder cancer.
- Cyclooxygenase-2 expression in the adenoma-carcinoma sequence of human gallbladder.
- Safety and outcome of endoscopic snare excision of the major duodenal papilla.
- Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part
- From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic
- Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma.
- [Fortuitous discovery of gallbladder cancer]
- Diet and gallbladder cancer: a case-control study.
Table of Contents
1
UI - 11960212
AU - Wakai T; Shirai Y; Hatakeyama K
TI -
Radical second resection provides survival benefit for patients with T2
gallbladder carcinoma first discovered after laparoscopic
cholecystectomy.
SO - World J Surg 2002 Jul;26(7):867-71
AD - Division of Digestive and General Surgery, Niigata University Graduate
School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata
City, 951-8510, Japan.
Port site recurrence or peritoneal seeding is a fatal complication
following laparoscopic cholecystectomy for gallbladder carcinoma. The
aims of this retrospective analysis were to determine the association of
gallbladder perforation during laparoscopic cholecystectomy with port
site/peritoneal recurrence and to determine the role of radical second
resection in the management of gallbladder carcinoma first diagnosed
after laparoscopic cholecystectomy. A total of 28 patients undergoing
laparoscopic cholecystectomy for gallbladder carcinoma were analyzed, of
whom 10 had a radical second resection. Five patients had recurrences;
port site/peritoneum recurrence in 3 and distant metastasis in 2. The
incidence of port site/peritoneal recurrence was higher in patients with
gallbladder perforation (3/7, 43%) than in those without (0/21, 0%) (p =
0.011). The outcome after laparoscopic cholecystectomy was worse in 7
patients with gallbladder perforation (cumulative 5-year survival of
43%) than in those without (cumulative 5-year survival of 100%) (p
<0.001). Among 13 patients with a pT2 tumor, the outcome after radical
second resection (cumulative 5-year survival of 100%) was better than
that after laparoscopic cholecystectomy alone (cumulative 5-year
survival of 50%) (p = 0.039), although there was no survival benefit of
radical second resection in the 15 patients with a pT1 tumor (p = 0.65).
In conclusion, gallbladder perforation during laparoscopic
cholecystectomy is associated with port site/peritoneal recurrence and
worse patient survival. Radical second resection may be beneficial for
patients with pT2 gallbladder carcinoma first discovered after
laparoscopic cholecystectomy.
2
UI - 11077323
AU - Csendes A; Becerra M; Rojas J; Medina E
TI -
Number and size of stones in patients with asymptomatic and symptomatic
gallstones and gallbladder carcinoma: a prospective study of 592 cases.
SO - J Gastrointest Surg 2000 Sep-Oct;4(5):481-5
AD - Department of Surgery and School of Public Health, Faculty of Medicine,
University of Chile, Santiago, Chile.
The development of gallbladder carcinoma has been correlated with the
presence of a single large gallstone in two retrospective studies. The
objective of the present study was to determine the number and size of
gallstones in patients with gallbladder carcinoma compared to
asymptomatic and symptomatic female patients with gallstones. The
following three groups of patients were included in this prospective
trial: (A) 78 asymptomatic patients with gallstones; (B) 365 symptomatic
patients with gallstones; and (C) 149 patients with gallbladder
carcinoma. At the end of the operation, the resected gallbladder was
opened and the number of stones counted. The maximum size of the stones
was determined using calipers. Patients with gallbladder carcinoma were
significantly older than patients in the other two groups (P <0.001). In
the group with asymptomatic gallstones, there were significantly more
patients with one single stone, whereas in the group with gallbladder
carcinoma there were significantly more patients with multiple stones
(more than 11; P <0.01). Patients with gallbladder carcinoma had
significantly larger stones, regardless of the number of stones present
(P <0.001). We postulate that the increase in the number and size of the
stones among patients with gallbladder carcinoma could simply be an
effect of aging or it could be a reflection of the long-term presence of
stones in the gallbladder rather than some particular chemical or
physical influence.
3
UI - 11154487
AU - Hintze RE; Abou-Rebyeh H; Adler A; Veltzke-Schlieker W; Felix R;
TI -
Wiedenmann B
Magnetic resonance cholangiopancreatography-guided unilateral endoscopic
stent placement for Klatskin tumors.
SO - Gastrointest Endosc 2001 Jan;53(1):40-6
AD - Department of Internal Medicine, Division of Hepatology and
Gastroenterology, University Hospital Charite, Campus Virchow,
Humboldt-University, Berlin, Germany.
BACKGROUND: Advanced and incurable Klatskin tumors of Bismuth-type III
and IV cause obstructive jaundice. Palliation of patients with Klatskin
tumors is usually carried out by bilateral endoscopic stent placement.
Endoscopic retrograde cholangiography (ERC) in such patients is
associated with a comparatively high morbidity and mortality mainly due
to postprocedure bacterial cholangitis. To reduce ERC-related
complications the outcome of replacing ERC with magnetic resonance
cholangiopancreatography (MRCP) was investigated. Subsequently,
unilateral contrast injection and stent placement were performed, thus
avoiding bilateral contrast injection and stent insertion. METHODS:
Patients thought to have a Klatskin tumor underwent clinical evaluation,
laboratory, and noninvasive imaging studies before ERC. Patients were
enrolled in this feasibility study if investigators agreed with the
clinical diagnosis of an advanced and incurable Klatskin tumor. MRCP
images were used to determine the predominate ductal drainage for the
liver segments thus directing stent placement. Based on these findings,
unilateral ERC and subsequent unilateral stent placement were performed.
Antibiotics were not given before ERC. Amsterdam-type stents (10F) were
placed and replaced routinely at 2 months. In cases of earlier
occlusion, the stents were replaced immediately. RESULTS: Thirty-five
patients underwent MRCP, ERC, and unilateral stent deployment. Two
further patients enrolled after MRCP were withdrawn because ERC could
not be carried out. In 35 patients with unilateral stents bilirubin
levels decreased (18.9 +/- 6.3 mg/dL to 3.2 +/- 2.3 mg/dL) and jaundice
resolved in 86%. After first stent deployment, post-ERC bacterial
cholangitis occurred in 6% (2 of 35) of patients. CONCLUSIONS: This new
method of MRCP-guided endoscopic unilateral stent placement could reduce
ERC-related complications caused by initial stent deployment.The results
of this study justify a randomized prospective comparative trial.
4
UI - 11280526
AU - Kapoor VK
TI -
Incidental gallbladder cancer.
SO - Am J Gastroenterol 2001 Mar;96(3):627-9
5
UI - 12177780
AU - Wistuba II; Maitra A; Carrasco R; Tang M; Troncoso P; Minna JD; Gazdar
TI -
AF
High resolution chromosome 3p, 8p, 9q and 22q allelotyping analysis in
the pathogenesis of gallbladder carcinoma.
SO - Br J Cancer 2002 Aug 12;87(4):432-40
AD - Department of Anatomic Pathology, Pontificia Universidad Catolica de
Chile, Marcoleta 367, P.O. Box 114-D, Santiago, Chile.
iwistuba@med.puc.cl
Our recent genome-wide allelotyping analysis of gallbladder carcinoma
identified 3p, 8p, 9q and 22q as chromosomal regions with frequent loss
of heterozygosity. The present study was undertaken to more precisely
identify the presence and location of regions of frequent allele loss
involving those chromosomes in gallbladder carcinoma. Microdissected
tissue from 24 gallbladder carcinoma were analysed for PCR-based loss of
heterozygosity using 81 microsatellite markers spanning chromosome 3p
(n=26), 8p (n=14), 9q (n=29) and 22q (n=12) regions. We also studied the
role of those allele losses in gallbladder carcinoma pathogenesis by
examining 45 microdissected normal and dysplastic gallbladder epithelia
accompanying gallbladder carcinoma, using 17 microsatellite markers.
Overall frequencies of loss of heterozygosity at 3p (100%), 8p (100%),
9q (88%), and 22q (92%) sites were very high in gallbladder carcinoma,
and we identified 13 distinct regions undergoing frequent loss of
heterozygosity in tumours. Allele losses were frequently detected in
normal and dysplastic gallbladder epithelia. There was a progressive
increase of the overall loss of heterozygosity frequency with increasing
severity of histopathological changes. Allele losses were not random and
followed a sequence. This study refines several distinct chromosome 3p,
8p, 9q and 22q regions undergoing frequent allele loss in gallbladder
carcinoma that will aid in the positional identification of tumour
suppressor genes involved in gallbladder carcinoma pathogenesis.
6
UI - 12140616
AU - Ouchi K; Mikuni J; Kakugawa Y; Organizing Committee, The 30th Annual
TI -
Congress of the Japanese Society of Biliary Surgery
Laparoscopic cholecystectomy for gallbladder carcinoma: results of a
Japanese survey of 498 patients.
SO - J Hepatobiliary Pancreat Surg 2002;9(2):256-60
AD - Department of Surgery, Miyagi Cancer Center Hospital, 47-1 Nodayama
Shiode-Medishima, Natori 981-1293, Japan.
BACKGROUND/PURPOSE: The long-term effects of initial laparoscopic
cholecystectomy on the prognosis of patients with GBC remain unknown
because of the limited numbers of patients reported from single
institutions. This study was designed to determine the long-term
prognosis of patients with gallbladder carcinoma (GBC) who had undergone
laparoscopic cholecystectomy (LC), and to clarify the role of LC for the
treatment of GBC and the benefit of aggressive additional excision.
METHODS: The clinical courses and outcomes of 498 patients with
laparoscopically removed GBC registered in a nationwide survey were
examined. Written questionnaires sent to members of the Japanese Society
of Biliary Surgery included questions on Preoperative diagnosis, timing
and methods to obtain final diagnosis, depth of invasion, second
surgical procedure, prognosis of patients, and type of recurrence, if
any. RESULTS: The 5-year survival rates of patients after LC according
to the depth of invasion were as follows: 99% in those with pT1a
(limited to the mucosa), 95% in those with pT1b (muscularis), 70% in
those with pT2 (subserosa), 20% in those with pT3 (serosa), and 0% in
those with pT4 (serosa with invasion to adjacent organs). Perforation of
the gallbladder during LC was found in 20% of the patients. Patients
with gallbladders perforated during LC showed a significantly lower
survival rate than did those without perforated gallbladders ( P <
0.01). Additional excision during or after LC was carried out in 48% of
the patients, and the frequency of additional excision increased in
accordance with the depth of invasion. Compared with patients who
underwent LC only, additional excision resulted in better survival in
patients with pT2 or pT3 tumors ( P = 0.051 and P < 0.05, respectively),
but this difference was not found in patients with pT1 or pT4 tumors.
CONCLUSIONS: LC is not likely to worsen the survival rate of patients
with GBC compared with the survival rate of patients undergoing a
standard open radical procedure, as long as additional excision is
conducted for patients with laparoscopically removed pT2 or pT3 GBCs.
Special attention should be paid to prevention of bile spillage during
LC.
7
UI - 12168833
AU - Suto T; Sugai T; Habano W; Uesugi N; Kanno S; Saito K; Nakamura S
TI -
Allelotype analysis of the PTEN, Smad4 and DCC genes in biliary tract
cancer.
SO - Anticancer Res 2002 May-Jun;22(3):1529-36
AD - Department of Surgery I, School of Medicine, Iwate Medical University,
Morioka, Japan.
Aberrations of the PTEN, Smad4 and DCC genes have not been determined in
biliary tract cancers. We performed allelotype analysis to screen for
alterations of these genes. We looked for the presence of allelic
imbalance (AI) at the PTEN and Smad4 genes in extrahepatic bile duct
(EHBD) and ampullary cancers using polymorphic microsatellite markers.
These tumors were also examined for AI at the DCC gene using polymerase
chain reaction amplification of variable numbers of tandem repeats. AI
at the PTEN, Smad4 and DCC genes was observed in 5.3%, 8.3% and 20.7%,
respectively, of EHBD tumor cases. AI at the PTEN, Smad4 and DCC genes
was detected in 13.3%, 50% and 8.3%, respectively, of ampullary cancer
cases. Our results suggest that (a) alteration of the Smad4 gene is a
major factor in the development of ampullary cancer and (b) PTEN, Smad4
and DCC genes are altered infrequently in EHBD cancers.
8
UI - 11956586
AU - Nakamura T; Ajiki T; Murao S; Kamigaki T; Maeda S; Ku Y; Kuroda Y
TI -
Prognostic significance of S100A4 expression in gallbladder cancer.
SO - Int J Oncol 2002 May;20(5):937-41
AD - Department of Biomedical Informatics, Kobe University Graduate School of
Medicine, Kobe 650-0017, Japan. tetsun@med.kobe-u.ac.jp
The calcium-binding protein S100A4 has been characterized as a
metastasis-inducing molecule, and regulates cell motility and
invasiveness of cancer cells. In order to clarify the significance of
the expression of S100A4 as a prognostic factor in gallbladder cancer,
S100A4 expression in resected gallbladder cancers were examined using an
immunohistochemical staining technique. The relationship between S100A4
expression and clinicopathological factors including prognosis were
evaluated. Twenty-five of 60 cases (42%) demonstrated positive staining
for S100A4. There was no statistically significant association between
S100A4 and histological grade, T, N, M factor, presence of stone, or
stage. Kaplan-Meier method showed the 5-year survival rate of the group
staining positive for S100A4 (31.5%) to be statistically poorer than
that of the group staining negative for S100A4 (78.2%). Also in T2
cases, the 5-year survival rate of the group staining positive for
S100A4 (57.1%) was statistically poorer than that of the group staining
negative for S100A4 (83.3%). On univariate analysis, positive staining
for S100A4 was a significant prognostic factor, and the hazard ratio was
4.05. On multivariate analysis, positive staining for S100A4 is also a
significant predictor of prognosis second to T factor. These results
indicate that positive staining for S100A4 is useful in assessing the
prognosis of patients with gallbladder cancer as well as TNM factors.
9
UI - 12190199
AU - Seki S; Kitada T; Sakaguchi H; Hirohashi K; Kinoshita H
TI -
Cyclooxygenase-2 expression in the adenoma-carcinoma sequence of human
gallbladder.
SO - Am J Gastroenterol 2002 Aug;97(8):2146-7
10
UI - 12145603
AU - Norton ID; Gostout CJ; Baron TH; Geller A; Petersen BT; Wiersema MJ
TI -
Safety and outcome of endoscopic snare excision of the major duodenal
papilla.
SO - Gastrointest Endosc 2002 Aug;56(2):239-43
AD - Developmental Endoscopy Unit, Division of Gastroenterology and
Hepatology, Mayo Clinic, Rochester, Minnesota 55902, USA.
BACKGROUND: The optimal management of adenoma of the major duodenal
papilla is not established. Options include surgical excision,
endoscopic ablative techniques, snare excision, and observation with
periodic biopsies. The aims of this retrospective study were to
determine the safety and outcome of snare excision of the papilla.
METHODS: Twenty-eight snare excisions of the papilla were performed in
26 patients. Sixteen had familial adenomatous polyposis. In 22
procedures, a minisnare was used, and in 6 cases a prototype snare was
designed for excision of the papilla. Pancreatic stents were placed as a
prophylactic measure at the discretion of the endoscopist (n = 10).
RESULTS: Histopathologically, resected tissue included 25 adenomas, 1
inflammatory polyp, 1 invasive malignancy, and 1 normal papilla.
Immediate complications were minor bleeding (n = 2), mild pancreatitis
(n = 4) and a duodenal perforation (n = 1). The presence (n = 10) or
absence (n = 18) of a pancreatic stent did not correlate with subsequent
pancreatitis (2 in each group, p = NS). Follow-up was available for 21
patients (median, 9 months; range, 2-32 months). Pancreatic duct
stenosis at the papillectomy site resulted in pancreatitis in 2 patients
(17%) at, respectively, 4 months and 24 months. Follow-up endoscopy
revealed recurrent/residual adenomatous tissue in 2 (10%). CONCLUSIONS:
Snare excision of the major duodenal papilla was well tolerated. Most
complications were mild except for a small duodenal perforation.
Stenosis of the pancreatic duct orifice with pancreatitis may be a late
complication.
11
UI - 12192322
AU - Yeo CJ; Cameron JL; Lillemoe KD; Sohn TA; Campbell KA; Sauter PK;
TI -
Coleman J; Abrams RA; Hruban RH
Pancreaticoduodenectomy with or without distal gastrectomy and extended
retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part
2: randomized controlled trial evaluating survival, morbidity, and
mortality.
SO - Ann Surg 2002 Sep;236(3):355-66; discussion 366-8
AD - Department of Surgery, The Johns Hopkins Medical Institutions,
Baltimore, Maryland 21287, USA. cyeo@jhmi.edu
OBJECTIVE: To evaluate, in a prospective, randomized single-institution
trial, the end points of operative morbidity, operative mortality, and
survival in patients undergoing standard versus radical (extended)
pancreaticoduodenectomy. SUMMARY BACKGROUND DATA: Numerous retrospective
reports and a few prospective randomized trials have suggested that the
performance of an extended lymphadenectomy in association with a
pancreaticoduodenal resection may improve survival for patients with
pancreatic and other periampullary adenocarcinomas. METHODS: Between
were enrolled in a prospective, randomized single-institution trial.
After intraoperative verification (by frozen section) of margin-negative
resected periampullary adenocarcinoma, patients were randomized to
either a standard pancreaticoduodenectomy (removing only the
peripancreatic lymph nodes en bloc with the specimen) or a radical
(extended) pancreaticoduodenectomy (standard resection plus distal
gastrectomy and retroperitoneal lymphadenectomy). All pathology
specimens were reviewed, fully categorized, and staged. The
postoperative morbidity, mortality, and survival data were analyzed.
RESULTS: Of the 299 patients randomized, 5 (1.7%) were subsequently
excluded because their final pathology failed to reveal periampullary
adenocarcinoma, leaving 294 patients for analysis (146 standard vs. 148
radical). The two groups were statistically similar with regard to age
(median 67 years) and gender (54% male). All the patients in the radical
group underwent distal gastric resection, while 86% of the patients in
the standard group underwent pylorus preservation ( <.0001). The mean
operative time in the radical group was 6.4 hours, compared to 5.9 hours
in the standard group ( =.002). There were no significant differences
between the two groups with respect to intraoperative blood loss,
transfusion requirements (median zero units), location of primary tumor
(57% pancreatic, 22% ampullary, 17% distal bile duct, 3% duodenal), mean
tumor size (2.6 cm), positive lymph node status (74%), or positive
margin status on final permanent section (10%). The mean total number of
lymph nodes resected was significantly higher in the radical group. Of
the 148 patients in the radical group, only 15% (n = 22) had metastatic
adenocarcinoma in the resected retroperitoneal lymph nodes, and none had
retroperitoneal nodes as the only site of lymph node involvement. One
patient in the radical group with negative pancreaticoduodenectomy
specimen lymph nodes had a micrometastasis to one perigastric lymph
node. There were six perioperative deaths (4%) in the standard group
versus three perioperative deaths (2%) in the radical group ( = NS). The
overall complication rates were 29% for the standard group versus 43%
for the radical group ( =.01), with patients in the radical group having
significantly higher rates of early delayed gastric emptying and
pancreatic fistula and a significantly longer mean postoperative stay.
With a mean patient follow-up of 24 months, there were no significant
differences in 1-, 3-, or 5-year and median survival when comparing the
standard and radical groups. CONCLUSIONS: Radical (extended)
pancreaticoduodenectomy can be performed with similar mortality but some
increased morbidity compared to standard pancreaticoduodenectomy. The
data to date fail to indicate that a survival benefit is derived from
the addition of a distal gastrectomy and retroperitoneal lymphadenectomy
to a pylorus-preserving pancreaticoduodenectomy.
12
UI - 11896229
AU - Levy AD; Murakata LA; Abbott RM; Rohrmann CA Jr
TI -
From the archives of the AFIP. Benign tumors and tumorlike lesions of
the gallbladder and extrahepatic bile ducts: radiologic-pathologic
correlation. Armed Forces Institute of Pathology.
SO - Radiographics 2002 Mar-Apr;22(2):387-413
AD - Department of Radiologic Pathology, Armed Forces Institute of Pathology,
Washington, DC 20306-6000, USA.
A diverse spectrum of benign tumors and tumorlike lesions arises from
the gallbladder and bile ducts, and despite their diversity, these
lesions share common embryologic origins and histologic characteristics.
Although these lesions are relatively uncommon, their importance lies in
their ability to mimic malignant lesions in these locations. Benign
neoplasms are derived from the epithelial and nonepithelial structures
that compose the normal gallbladder and bile ducts. The epithelium gives
rise to adenomas, cystadenomas, and the unusual condition of biliary
papillomatosis. Granular cell tumors, neurofibromas, ganglioneuromas,
paragangliomas, and leiomyomas are examples of benign tumors that may
originate from nonepithelial structures. Tumorlike lesions are more
commonly found in the gallbladder and include xanthogranulomatous
cholecystitis, adenomyomatous hyperplasia, cholesterol polyps, and
heterotopias. In the clinical setting of a patient with nonspecific
abdominal complaints or symptoms of biliary obstruction, the discovery
of a gallbladder or bile duct polyp or mass, gallbladder wall
thickening, or biliary stricture is most often indicative of malignancy.
However, the differential diagnosis should include benign tumors and
tumorlike lesions. The preoperative determination of a benign lesion may
significantly alter therapy and patient prognosis.
13
UI - 12190678
AU - Yamaguchi R; Nagino M; Oda K; Kamiya J; Uesaka K; Nimura Y
TI -
Perineural invasion has a negative impact on survival of patients with
gallbladder carcinoma.
SO - Br J Surg 2002 Sep;89(9):1130-6
AD - Department of Surgery, Division of Surgical Oncology, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550,
Japan.
BACKGROUND: The clinical significance of perineural invasion of
gallbladder carcinoma remains unclear. The aim of this study was to
elucidate the incidence and mode of perineural invasion of gallbladder
carcinoma and clarify its prognostic significance. METHODS: A
clinicopathological study was conducted on 68 patients who underwent
attempted curative resection for gallbladder carcinoma. According to the
pathological tumour node metastasis (pTNM) classification of the Union
Internacional Contra la Cancrum, there were five (7 per cent), nine (13
per cent), 20 (29 per cent) and 34 (50 per cent) patients with pT1, pT2,
pT3 and pT4 disease respectively. Twenty patients (29 per cent) had pM1
disease, including involved para-aortic nodes, liver metastases and
localized dissemination. RESULTS: The overall incidence of perineural
invasion was 71 per cent (48 of 68 patients). Forty-four (96 per cent)
of 46 patients with extrahepatic bile duct invasion had perineural
invasion. Although several histological factors were associated with
perineural invasion, multivariate analysis demonstrated that
extrahepatic bile duct invasion was the only significant factor
correlated with perineural invasion (odds ratio 99.0, P < 0.001). The
perineural invasion index, defined as the ratio of the number of
involved nerves to the total number of nerves examined, was
significantly higher at the centre than in the proximal and distal parts
of the tumour in the 46 patients with extrahepatic bile duct invasion (P
< 0.001). The 5-year survival rate for patients with perineural invasion
was significantly lower than that for patients with no invasion (7
versus 72 per cent; P < 0.001). Cox proportional hazard analysis
identified perineural invasion (relative risk (RR) 5.3, P < 0.001) and
lymph node metastasis (RR 2.5, P = 0.008) as significant independent
prognostic factors. CONCLUSION: Perineural invasion is common in
advanced gallbladder carcinoma and has a significant negative impact on
patient survival.
14
UI - 11912682
AU - Chiche L; Metairie S
TI -
[Fortuitous discovery of gallbladder cancer]
SO - J Chir (Paris) 2001 Dec;138(6):336-41
AD - Service de Chirurgie Digestive, CHU Caen cote de Nacre, F 14000 Caen.
chiche-l@chu-caen.fr
The prognosis of gallbladder cancer is basically dependent on the
histological stage at diagnosis. In practice, the discovery of a small
cancer of the bladder, generally during cholecystectomy give the patient
a better care for curative treatment. The advent of laparoscopy has
increased the number of cholecstectomies and could increase the
frequency of this situation but also raises the difficult problem of
metastatic dissemination. In the literature the figures on parietal
metastasis after laparoscopy have ranged from 125% to 19%. The median
delay to diagnosis of recurrence is 6 months. The cause of this
phenomenon (role of the pneumoperitoneum) remains poorly elucidated.
Risk factors for the development of a metastasis on the trocar orifice
are: rupture of the gallbladder perioperatively and extraction of the
gallbladder without protection. It is important to keep in mind this
exceptional but serious risk and apply rigorous operative technique. In
case of suspected gallbladder we do not advocate laparoscopy. Surgery
(hepatectomy, lymphodenectomy, possibly resection of the biliary tract)
would be indicted for all stages except pTis and T1a, taking into
consideration the localization of the tumor and the patient's general
status. It is also classical to recommend resection of the trocar
orifices after laparoscopic cholecystectomy. There is a dual challenge
today for small-sized gallbladder cancer: improving treatment and
avoiding poorer prognosis due to the specific problems raised by
laparoscopy.
15
UI - 12195163
AU - Pandey M; Shukla VK
TI -
Diet and gallbladder cancer: a case-control study.
SO - Eur J Cancer Prev 2002 Aug;11(4):365-8
AD - Department of Surgical Oncology, Regional Cancer Centre, Medical College
PO, Thiruvananthapuram, Kerala 695 011, India. manojpandey@rcctvm.org
Cancer of the gallbladder is rare but fatal, and has an unusual
geographic and demographic distribution. Gallstones and obesity have
been suggested as possible risk factors. As diet is known to influence
both these factors, we carried out the present study to evaluate the
possible role of diet in gallbladder carcinogenesis. A case-control
study involving 64 newly diagnosed cases of gallbladder cancer and 101
cases of gallstones was carried out. The dietary evaluation was carried
out by the dietary recall method based on a preset questionnaire
developed specifically for the present study, keeping in mind the common
dietary habits prevailing in this part of the world. Odds ratios (OR)
and 95% confidence interval (CI) were calculated for various dietary
items. A significant reduction in odds ratio was seen with the
consumption of radish (OR 0.4; 95% CI 0.17-0.94), green chilli (OR 0.45;
95% CI 0.21-0.94) and sweet potato (OR 0.33; 95% CI 0.13-0.83) among
vegetables, and mango (OR 0.4; 95% CI 0.16-0.99), orange (OR; 0.45; 95%
CI 0.22-0.93), melon (OR 0.3; 95% CI 0.14-0.64) and papaya (OR 0.44; 95%
0.2-0.64) among fruits. A reduction in odds was also seen with the
consumption of cruciferous vegetables, beans, onion and turnip, however
the difference was not statistically significant. On the other hand, an
increase in the odds was observed with consumption of capsicum (OR 2.2),
beef (OR 2.58), tea (OR 1.98), red chilli (OR 1.29) and mutton (OR 1.2),
however the difference was statistically not significant. In conclusion,
the results of the present study show a protective effect of vegetables
and fruits on gallbladder carcinogenesis, but red meat (beef and mutton)
was found to be associated with increased risk of gallbladder cancer.
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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