Transcript The Scope of Surgery in Gall Bladder Carcinoma Dr Sanjay De Bakshi MS{Cal}; FRCS{Eng;Edin}

The Scope of Surgery in Gall
Bladder Carcinoma
Dr Sanjay De Bakshi
MS{Cal}; FRCS{Eng;Edin}
Recent Papers on Surgery in Gall
Bladder Cancer
• Kongressbd Dtsch Ges Chir Kongr.
2002;119:79-81.
•
[Surgical therapy of advanced gallbladder
carcinoma]
Rau H, Schauer R, Zimmermann A, Angele MK,
Trapp O, Schildberg FW.
Synopsis
• This retrospective study included 204 patients who were
subjected to surgery due to advanced gall bladder cancer at the
Klinikum Grosshadern. Mean survival time of all patients was
4.5 months. Advancement of the tumor stage resulted in a
decreased percentage of possible R0 resections (T3 n = 48, R0
31%, T4 n = 87, R0 13%).
• Nonetheless, R0 resections of T3 tumors significantly
increased the survival rate compared to R1 and R2
resections (mean survival 20.2 vs. 4.5 months). R0
resections of T4 tumors also significantly attenuated the
survival rate (18.1 vs. 2.4 months compared to R1 and R2
resections).
• Thus, diagnostic procedures have to focus on identifying
patients with possible R0 resections and perform extensive
resections on those patients.
The concern
• The paper does NOT address the issue of
“MORBIDITY” during the post operative
period.
Role of Laparoscopic
Cholecystectomy
J La State Med Soc. 2002 Jul-Aug;154(4):196-9.
Primary carcinoma of the gall bladder: a review of our
experience.
Cunningham CC, Zibari GB, Johnston LW.
Synopsis
• Laparoscopic cholecystectomy was performed in 9
(31%) patients. All patients with carcinoma in situ,
stage I, and stage II disease were living at last follow
up. Average survival after diagnosis for stage III
disease was 5.7 months, and for stage IV disease
was 3.1 months. Our results and that of others lead
us to believe that in any patient with a pre-operative
or intra-operative suspicion of gallbladder cancer an
open procedure is indicated. Furthermore, we believe
that laparoscopic cholecystectomy may be
inadequate and contraindicated in all but carcinoma
in situ and stage I disease.
I believe that we still have lots to do-
but then, humans have always been
known to be persistent and resilient.