Early Gallbladder Cancer: Clinical, Morphological, Therapeutic and Evolutionary Aspects

Abstract

Introduction: The early cancer of gallbladder is an entity which is not well recognized currently. It is a cancer which does not extend beyond the muscularis layer of the gallbladder and it is characterized in almost of cases by the absence of lymph node and visceral invasion. Patients and Method: We have conducted this retrospective study of all our cases of early gallbladder cancer treated in our surgical unit. We have studied these through clinical, morphological, therapeutical and evolutionary aspects. Results: Of 202 gallbladder carcinoma, 33 cancers were classified as early cancer. 25 were females and 8 were males. The mean age was 56.4 years (41 - 70 years). All patients were free of gallbladder cancer symptoms and all except one had normal CEA and CA19.9. 2 patients had synchronous tumors (one colonic cancer and one rectal cancer). For 16 patients , the diagnosis was done by ultrasonography and 17 by histological examination of the specimen removed for biliary lithiasis. 8 patients had PT1a tumor (confined only to mucosa) and 25 had PT1b tumor (tumor infiltration of the muscular layer). For 19 patients who benefited from extensive lymphadenectomy , only one (5 . 3%) had lymph node infiltration. 16 patients had a simple cholecystectomy and in two cases , the cholecystectomy was associated with bile duct resection. 17 patients had hepatectomy with extensive lymphadenectomy. 2 patients had a simultaneous right colectomy and abdominoperineal resection and another one benefited from choledocal cyst resection. 3 patients benefited from stone removal from bile duct and two had tumor removal from bile duct (ruptured tumor in the bile duct). 1 patient (3.7%) died in postoperative course (hospital mortality). In the follow-up period, 4 patients died from intercurrent causes. Two patients presented a recurrence at 14 and 36 months and died respectively at 19 and 42 months. One patient presented a bile duct cancer at 66 months. She died at 78 months after palliative treatment. Currently, 22 patients (66.7%) are still alive without recurrence with mean and median survival of 53 and 31 months. Conclusion: Early gallbladder cancer is an entity which must be know n by the radiologist and the surgeon. Recognized on time and well treated, early gallbladder cancer can be cured and its prognosis is excellent.