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Takayama Y, Koga T, Hamada Y, Tanaka S, Sato K, Murayama R, Ishida Y, Kajiwara M, Yoshimitsu K. Prediction of the wall-invasion pattern of advanced gallbladder carcinoma using extracellular volume fraction. Jpn J Radiol 2025:10.1007/s11604-025-01768-8. [PMID: 40106212 DOI: 10.1007/s11604-025-01768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 03/03/2025] [Indexed: 03/22/2025]
Abstract
PURPOSE This study aimed to evaluate the utility of extracellular volume (ECV) fraction for predicting wall-invasion patterns in advanced gallbladder carcinoma (GBCA). MATERIALS AND METHODS Patients who had surgically resected GBCA at a single institution were retrospectively evaluated. All patients underwent computed tomography (CT) before the surgery. Based on pathological examinations, the wall-invasion pattern of GBCA was classified into two groups: infiltrative growth (IG, n = 19) and destructive growth (DG, n = 11). ECV map was generated by inputting the patients' hematocrit values and subtraction algorithms using pre-contrast and equilibrium phase images. CT parameters were evaluated by two radiologists (Rad1 and Rad2). The Mann-Whitney U test was performed to identify significant CT parameters for differentiating between the two groups. The diagnostic ability was measured using receiver operating characteristic (ROC) curve analysis. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method, and differences between the two groups were compared using the log-rank test. RESULTS Thirty patients (mean age, 75.5 years; 20 men) were evaluated. Mean ECV fraction of the DG-type (Rad1, 34.5%; Rad2, 34.1%) was significantly higher than that of the IG-type (Rad1, 28.5%; Rad2, 28.8%) (p < 0.05). The ECV values of the two radiologists indicated that the areas under the ROC curves for differentiation between the two groups were Rad1, 0.91 and Rad2, 0.84 (p < 0.05). Medium RFS of the DG-type (970 days) was significantly shorter than that of the IG-type (2200 days) (p < 0.05). CONCLUSION ECV fraction demonstrates potential as the most valuable predictor of the DG type of GBCA, which has a higher recurrence rate compared with the IG type. However, further large-scale multi-center studies are required to validate these findings.
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Affiliation(s)
- Yukihisa Takayama
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan.
| | - Takehiko Koga
- Departments of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Yoshihiro Hamada
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Shinji Tanaka
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Keisuke Sato
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Ryo Murayama
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Yusuke Ishida
- Departments of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Masatoshi Kajiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Kengo Yoshimitsu
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
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Cui Z, Le Y, Liu H, Feng L, Zhang S. Comprehensive treatment of gallbladder cancer: a case report. Ann Med Surg (Lond) 2024; 86:4811-4815. [PMID: 39118674 PMCID: PMC11305716 DOI: 10.1097/ms9.0000000000002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/13/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction and importance Gallbladder cancer is an extremely aggressive digestive system tumor. It is difficult to treat as early symptoms are insidious, and patients are usually diagnosed in advanced stages. The authors' case highlights the need for effective treatment strategies and underscores the critical role of an individualized approach in the management of complicated gallbladder cancer. Case presentation The authors report a patient admitted to the hospital with back pain and discomfort who was diagnosed with advanced gallbladder cancer. The patient received two cycles of chemotherapy with gemcitabine and cisplatin (GC), but the response was unsatisfactory. The authors changed the treatment regimen to gemcitabine and oxaliplatin (GEMOX) combined with targeted therapy (lenvatinib) and immunotherapy (toripalimab), and achieved significant therapeutic effect. Subsequently, the patient underwent "extended right hemihepatectomy, cholecystectomy, lymph node dissection of the hepatoduodenal ligament " and continued to receive combined therapy after surgery, and no tumor recurrence has been observed so far. Clinical discussion The authors delve into the challenges faced during treatment, exploring the subtle impact of modified regimens and the strategic integration of surgery and combination therapy. The focus of this study is on the intricate synergy between GEMOX, lenvatinib and teraplizumab, providing a holistic view of treatment effects and new insights into the clinical decision-making process. Conclusions This case emphasizes the success of precision medicine in the treatment of advanced gallbladder cancer. The adjustment of strategy can not only improve the therapeutic effect but also promote the success of surgical intervention. This case provides a valuable lesson in the holistic management of gallbladder cancer patients and prompts further reflection on the nuances of individualized therapeutic approaches in cancer treatment.
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Affiliation(s)
- Zhaoyang Cui
- Department of Graduate School, Hebei North University, Zhangjiakou
| | - Yi Le
- Department of Surgical Oncology, Shanghai Mengchao Cancer Hospital, Shanghai, China
| | - Hu Liu
- Department of Surgical Oncology, Shanghai Mengchao Cancer Hospital, Shanghai, China
| | - Linjing Feng
- Department of Surgical Oncology, Shanghai Mengchao Cancer Hospital, Shanghai, China
| | - Shaogeng Zhang
- Department of Surgical Oncology, Shanghai Mengchao Cancer Hospital, Shanghai, China
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3
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Cao J, Yan J, Hu J, Zhang B, Topatana W, Li S, Chen T, Jeungpanich S, Lu Z, Peng S, Cai X, Chen M. Estimating the influencing factors for T1b/T2 gallbladder cancer on survival and surgical approaches selection. Cancer Med 2023; 12:16744-16755. [PMID: 37366278 PMCID: PMC10501227 DOI: 10.1002/cam4.6297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The influencing factors, especially time to treatment (TTT), for T1b/T2 gallbladder cancer (GBC) patients remain unknown. We aimed to identify the influencing factors on survival and surgical approaches selection for T1b/T2 GBC. METHODS We retrospectively screened GBC patients between January 2011 and August 2018 from our hospital. Clinical variables, including patient characteristics, TTT, overall survival (OS), disease-free survival (DFS), surgery-related outcomes, and surgical approaches were collected. RESULTS A total of 114 T1b/T2 GBC patients who underwent radical resection were included. Based on the median TTT of 7.5 days, the study cohort was divided into short TTT group (TTT ≤7 days, n = 57) and long TTT group (TTT >7 days, n = 57). Referrals were identified as the primary factor prolonging TTT (p < 0.001). There was no significance in OS (p = 0.790), DFS (p = 0.580), and surgery-related outcomes (all p > 0.05) between both groups. Decreased referrals (p = 0.005), fewer positive lymph nodes (LNs; p = 0.004), and well tumor differentiation (p = 0.004) were all associated with better OS, while fewer positive LNs (p = 0.049) were associated with better DFS. Subgroup analyses revealed no significant difference in survival between patients undergoing laparoscopic or open approach in different TTT groups (all p > 0.05). And secondary subgroup analyses found no significance in survival and surgery-related outcomes between different TTT groups of incidental GBC patients (all p > 0.05). CONCLUSIONS Positive LNs and tumor differentiation were prognostic factors for T1b/T2 GBC survival. Referrals associating with poor OS would delay TTT, while the prolonged TTT would not impact survival, surgery-related outcomes, and surgical approaches decisions in T1b/T2 GBC patients.
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Affiliation(s)
- Jiasheng Cao
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Jiafei Yan
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Jiahao Hu
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Bin Zhang
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Win Topatana
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Shijie Li
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Tianen Chen
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Sarun Jeungpanich
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Ziyi Lu
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Shuyou Peng
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
- Department of General Surgerythe Second Affiliated Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Xiujun Cai
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Mingyu Chen
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
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MacLeod AN, Reichle JK, Szabo D, Cohen EB, Artiles C, Fulkerson CV, Kurihara M, Mattoon J. Ultrasonographic Appearance of Gallbladder Neoplasia in 14 Dogs and 1 Cat. Vet Radiol Ultrasound 2023. [PMID: 36867397 DOI: 10.1111/vru.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Ultrasonography is the most commonly used diagnostic imaging tool for gallbladder disease in veterinary medicine. Primary gallbladder neoplasia is an uncommon finding with variable prognosis for which no studies have been published describing their ultrasonographic appearance and diagnosis. This retrospective, multicenter, case series study examines the ultrasonographic appearance of gallbladder neoplasia with histologically or cytologically confirmed diagnoses. A total of 14 dogs and 1 cat were analyzed. All discrete masses were sessile in shape and varied in size, echogenicity, location, and gallbladder wall thickening. All studies with images showing Doppler interrogation exhibited vascularity. Cholecystoliths were an uncommon finding, being present in only one case in this study, unlike in humans. The final diagnosis of the gallbladder neoplasia was neuroendocrine carcinoma (8), leiomyoma (3), lymphoma (1), gastrointestinal stromal tumor (1), extrahepatic cholangiocellular carcinoma (1), and adenoma (1). Findings from this study indicate that primary gallbladder neoplasms have variable sonographic appearances and cytologic and histologic diagnoses.
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Affiliation(s)
| | | | | | - Eli B Cohen
- Department of Molecular Biomedical Sciences, NC State College of Veterinary Medicine, Raleigh, NC
| | - Charles Artiles
- Purdue University Veterinary Hospital, Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - Caroline V Fulkerson
- Purdue University Veterinary Hospital, Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - Manabu Kurihara
- Cummings Veterinary Medical Center, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - John Mattoon
- Veterinary Teaching Hospital, WSU College of Veterinary Medicine, Pullman, WA
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Chatterjee A, Mukhopadhyay S, Ghosh P, Shah D, Gehani A, Baheti A, Gupta B, Chandra A, Chaturvedi AK, Khoda J, Patra A, Lingegowda D, Sen S. Imaging Recommendations for Diagnosis, Staging, and Management of Hepatic and Biliary Tract Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
AbstractMajor hepatobiliary cancers include hepatocellular carcinoma, gallbladder carcinoma, and cholangiocarcinoma. There are multiple guidelines and recommendations for the imaging evaluation of these cancers. This article reviews and summarizes principles and recommendations of imaging in hepatobiliary cancers. The cross-sectional imaging protocol is similar among these lesions and is discussed at first followed by the separate discussion of each cancer.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Diva Shah
- Department of Radiology, HCG Cancer Centre, Ahmedabad, Gujarat, India
| | - Anisha Gehani
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Akshay Baheti
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Gupta
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Aditi Chandra
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Arvind K. Chaturvedi
- Department of Radiology and Interventional Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Jeevitesh Khoda
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Anurima Patra
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Dayananda Lingegowda
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
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Yang J, Li E, Wang C, Luo S, Fu Z, Peng J, Liao W, Wu L. Robotic versus open extended cholecystectomy for T1a-T3 gallbladder cancer: A matched comparison. Front Surg 2022; 9:1039828. [PMID: 36420415 PMCID: PMC9676919 DOI: 10.3389/fsurg.2022.1039828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/17/2022] [Indexed: 11/14/2024] Open
Abstract
BACKGROUND The feasibility and safety of robotic extended cholecystectomy (REC) are still uncertain. This study was performed to compare the short- and long-term outcomes of REC with those of open extended cholecystectomy (OEC) for T1a-T3 gallbladder cancer. METHODS From January 2015 to April 2022, 28 patients underwent REC in our center. To minimize any confounding factors, a 1:2 propensity score-matching analysis was conducted based on the patients' demographics, liver function indicators, T stage, and symptoms. The data regarding demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed. RESULTS The visual analogue scale score was significantly lower in the REC than OEC group immediately postoperatively (3.68 ± 2.09 vs. 4.73 ± 1.85, P = 0.008), on postoperative day 1 (2.96 ± 1.75 vs. 3.69 ± 1.41, P = 0.023), and on postoperative day 2 (2.36 ± 1.55 vs. 2.92 ± 1.21, P = 0.031). In addition, the REC group exhibited a shorter time to first ambulation (P = 0.043), a shorter time to drainage tube removal (P = 0.038), and a shorter postoperative stay (P = 0.037), but hospital costs were significantly higher in the REC group (P < 0.001). However, no statistically significant difference was found in the operation time (P = 0.134), intraoperative blood loss (P = 0.467), or incidence of postoperative morbidity (P = 0.227) or mortality (P = 0.289) between the REC and OEC groups. In regard to long-term outcomes, the 3-year disease-free survival rate was comparable between the OEC and REC groups (43.1% vs. 57.2%, P = 0.684), as was the 3-year overall survival rate (62.8% vs. 75.0%, P = 0.619). CONCLUSION REC can be an effective and safe alternative to OEC for selected patients with T1a-T3 gallbladder cancer with respect to short- and long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Wenjun Liao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linquan Wu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Li Y, Song Y, Zhang Y, Liu S. Progress in gallbladder cancer with lymph node metastasis. Front Oncol 2022; 12:966835. [PMID: 36072797 PMCID: PMC9441950 DOI: 10.3389/fonc.2022.966835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Gallbladder cancer (GBC) is a malignant tumor that originates from the mucosal lining of the gallbladder. It is distinctly regional and is common in certain geographic regions of developing countries. GBC has a high degree of insidiousness as well as a high propensity for metastatic spread, resulting in the majority of patients being diagnosed at an advanced stage. Lymph node metastasis (LNM) is fairly common in GBC patients and is an independent risk factor for a poor prognosis. This article is focused on the lymph node pathways and metastatic directions of GBC. Furthermore, it summarizes the different lymph node groupings, disease stages and treatments. In the future, it is of great significance to develop individualized treatment and predict the outcomes of GBC patients with different lymph node conditions.
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Affiliation(s)
- Yuhang Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yinghui Song
- Central Laboratory of Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yujing Zhang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Sulai Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- Central Laboratory of Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
- *Correspondence: Sulai Liu,
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8
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Đokic M, Stupan U, Licen S, Trotovsek B. Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer - institution experience with literature review. Radiol Oncol 2021; 56:208-215. [PMID: 34957726 PMCID: PMC9122290 DOI: 10.2478/raon-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. PATIENTS AND METHODS Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. RESULTS In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012-2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. CONCLUSIONS The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.
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Affiliation(s)
- Mihajlo Đokic
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Urban Stupan
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Sabina Licen
- Nursing Department, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Blaz Trotovsek
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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9
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Zia HA, Siddiqui UD. Biliary Tract Malignancies Related to Gallbladder Polyps, Primary Sclerosing Cholangitis, and Choledochal Cysts. Clin Liver Dis (Hoboken) 2021; 18:85-89. [PMID: 34584674 PMCID: PMC8450487 DOI: 10.1002/cld.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Hassaan A. Zia
- Center for Endoscopic Research and TherapeuticsUniversity of ChicagoChicagoIL
| | - Uzma D. Siddiqui
- Center for Endoscopic Research and TherapeuticsUniversity of ChicagoChicagoIL
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10
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Gupta P, Meghashyam K, Marodia Y, Gupta V, Basher R, Das CK, Yadav TD, Irrinki S, Nada R, Dutta U. Locally advanced gallbladder cancer: a review of the criteria and role of imaging. Abdom Radiol (NY) 2021; 46:998-1007. [PMID: 32945922 DOI: 10.1007/s00261-020-02756-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
Gallbladder carcinoma (GBC) is among one of the gastrointestinal malignancies with extremely dismal prognosis. This is due to the advanced stage at presentation. Majority of the patients with GBC are not considered candidates for surgery because of the locally advanced disease or metastases. However, with the accumulating evidence regarding the role of neoadjuvant chemotherapy, there is a need to correctly identify a subset of patients with locally advanced GBC who will benefit maximally from neoadjuvant chemotherapy and will be successfully downstaged to receive curative (R0) surgery. In this context, there is a lack of consensus and different groups have resorted to criteria for locally advanced disease eligible for neoadjuvant chemotherapy based on personal or institutional experiences. Imaging plays a critical role in the evaluation of patients with GBC as it helps stratify patients into resectable and unresectable. Imaging also has the potential to identify patients with locally advanced GBC and hence facilitate neoadjuvant chemotherapy and improve outcomes. In this review, we evaluate the various criteria for locally advanced GBC and the role of imaging in this scenario.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Kesha Meghashyam
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Yashi Marodia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vikas Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rajender Basher
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Chandan Krushna Das
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Thakur Deen Yadav
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Santhosh Irrinki
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Abstract
Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.
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12
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Yang XW, Chen JY, Wen ZJ, Li YL, Wang FY, Li L, Yang J, Yang PH, Zhang BH, Shen F. Effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma with radical resection. World J Surg Oncol 2020; 18:239. [PMID: 32891147 PMCID: PMC7487893 DOI: 10.1186/s12957-020-02015-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
Purposes This study was designed to evaluate the effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma (GBC) after radical resection (R0). Methods A total of 267 GBC patients who underwent R0 resection from January 2004 to December 2014 were enrolled, including 54 patients with preoperative jaundice and 213 patients without jaundice. The clinicopathological parameters between the two groups were compared, and the correlation between preoperative jaundice and the long-term prognosis was furtherly analyzed. Results Unilateral and multivariate analyses of 267 GBC patients showed that the depth of tumor invasion (pT stage), lymphatic metastasis, and hepatic invasion were independent prognostic factors. The univariate and multivariate analysis of 54 GBC patients with preoperative jaundice showed that only pT stage was an independent factor for prognosis. Furthermore, the intraoperative blood transfusion and pT stage were significant different between long-term survival (survive for more than 3 years) and those who died within 3 years (P < 0.05). Conclusion Preoperative jaundice was not the independent factor resulting in the poor long-term prognosis of gallbladder carcinoma after R0 resection. The pT stage was the only long-term prognostic factor in all GBC patients regardless of preoperative jaundice.
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Affiliation(s)
- Xin-Wei Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Jun-Yi Chen
- Department of General Surgery, The Fourth People's Hospital of Shanghai, North Sichuang Road 1878, Shanghai, 200081, Shanghai, China
| | - Zhi-Jian Wen
- Department of General Surgery, No.73 Army Hospital of PLA, Xiamen University, Xiamen, China
| | - Yu-Long Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Fei-Yu Wang
- Department of General Surgery, Jiangdu People's Hospital of Yangzhou City, Jiangsu Province, No. 9 Dongfanghong East Road, Yangzhou, China
| | - Liang Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Jue Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Ping-Hua Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Bao-Hua Zhang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
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Moradi F, Iagaru A. The Role of Positron Emission Tomography in Pancreatic Cancer and Gallbladder Cancer. Semin Nucl Med 2020; 50:434-446. [PMID: 32768007 DOI: 10.1053/j.semnuclmed.2020.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
18F-FDG-PET is complementary to conventional imaging in patients with clinical suspicion for exocrine pancreatic malignancies. It has similar if not superior sensitivity and specificity for detection of cancer, and when combined with contrast enhanced anatomic imaging of the abdomen, can improve diagnostic accuracy and aid in staging, assessment for resectability, radiation therapy planning, and prognostication. Various metabolic pathways affect FDG uptake in pancreatic ductal adenocarcinoma. The degree of uptake reflects histopathology, aggressiveness, metastatic potential, and metabolic profile of malignant cell and their interaction with cancer stroma. After treatment, FDG-PET is useful for detection of residual or recurrent cancer and can be used to assess and monitor response to therapy in unresectable or metastatic disease. The degree and pattern of uptake combined with other imaging features are useful in characterization of incidental pancreatic lesions and benign processes such as inflammation. Several novel PET radiopharmaceuticals have been developed to improve detection and management of pancreatic cancer. Gallbladder carcinoma is typically FDG avid and when anatomic imaging is equivocal PET can be used to assess metastatic involvement with high specificity and inform subsequent management.
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Affiliation(s)
- Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA.
| | - Andrei Iagaru
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA
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14
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Gamboa AC, Maithel SK. The Landmark Series: Gallbladder Cancer. Ann Surg Oncol 2020; 27:2846-2858. [PMID: 32474816 DOI: 10.1245/s10434-020-08654-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Indexed: 12/13/2022]
Abstract
Given the rarity of gallbladder carcinoma, level I evidence to guide the multimodal treatment of this disease is lacking. Since 2010, four randomized phase III clinical trials including ABC-02, PRODIGE-12/ACCORD-18, BILCAP, and BCAT, and a single-arm phase II trial (SWOG0809) have been reported on the use of adjuvant strategies for biliary malignancies. These trials have led to the recommendation that patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy and those with R1 margins could be considered for chemoradiotherapy. Because there is no level I evidence to guide neoadjuvant therapy or surgical management, current consensus is based on strong retrospective data. The following review summarizes available trials and highlights the best available evidence that form the basis of consensus statements for the multimodal management of gallbladder carcinoma.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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15
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Lee W. Diagnostic and Therapeutic Algorithm: Polypoid Lesions of the Gallbladder. DISEASES OF THE GALLBLADDER 2020:255-268. [DOI: 10.1007/978-981-15-6010-1_26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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16
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Jang E, Jeong J, Yim JH, Kim Y, Lee CH, Choi D, Chung H. Improved infrared spectroscopic discrimination between gall bladder (GB) polyps and GB cancer using component-descriptive spectral features of separated phases from bile. Analyst 2019; 144:4826-4834. [PMID: 31290490 DOI: 10.1039/c9an00878k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study demonstrates a unique strategy for enhancing infrared (IR) spectroscopic discrimination between gall bladder (GB) polyps and cancer. This strategy includes the separation of raw bile juice into three sections of organic, aqueous, and amphiphilic phases and a cooperative combination of all IR spectral features of each separated phase for the discrimination. Raw bile juice is viscous and complex in composition because it contains fatty acids, cholesterol, proteins, phospholipids, bilirubin, and other components; therefore, the acquisition of IR spectra providing more component-discernible information is fundamental for improving discrimination. For this purpose, raw bile juice was separated into an aqueous phase, mostly containing bile salts, an organic phase with isolated lipids, and an amphiphilic phase, mainly containing proteins. The subsequent IR spectra of each separated phase were mutually characteristic and complementary to each other. When all the IR spectral features were combined, the discrimination was improved compared to that using the spectra of raw bile juice with no separation. The cooperative integration of more component-specific spectra obtained from each separated phase enhanced the discrimination. In addition, the IR spectra of the major constituents in bile juice, such as bile acids, conjugated bile salts, lecithin, and cholesterol, were recorded to explain the IR features of each separated phase.
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Affiliation(s)
- Eunjin Jang
- Department of Chemistry and Research Institute for Convergence of Basic Science, Hanyang University, Seoul 04763, Republic of Korea.
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Hickman L, Contreras C. Gallbladder Cancer: Diagnosis, Surgical Management, and Adjuvant Therapies. Surg Clin North Am 2019; 99:337-355. [PMID: 30846038 DOI: 10.1016/j.suc.2018.12.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gallbladder cancer (GBC) is an often lethal disease, but surgical resection is potentially curative. Symptoms may be misdiagnosed as biliary colic; over half of new diagnoses are made after laparoscopic cholecystectomy for presumed benign disease. Gallbladder polyps >1 cm should prompt additional imaging and cholecystectomy. For GBC diagnosed after cholecystectomy, tumors T1b and greater necessitate radical cholecystectomy. Radical cholecystectomy includes staging laparoscopy, hepatic resection, and locoregional lymph node clearance to achieve R0 resection. Patients with locally advanced disease (T3 or T4), hepatic-sided T2 tumors, node positivity, or R1 resection may benefit from adjuvant chemotherapy. Chemotherapy increases survival in unresectable disease.
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Affiliation(s)
- Laura Hickman
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlo Contreras
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Liu F, Wang JK, Ma WJ, Yang Q, Hu HJ, Li FY. Clinical value of preoperative CA19-9 levels in evaluating resectability of gallbladder carcinoma. ANZ J Surg 2018; 89:E76-E80. [PMID: 30306702 DOI: 10.1111/ans.14893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/29/2018] [Accepted: 09/01/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Fei Liu
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Jun-Ke Wang
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Wen-Jie Ma
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Qin Yang
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Hai-Jie Hu
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Fu-Yu Li
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
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Serra C, Felicani C, Mazzotta E, Gabusi V, Grasso V, De Cinque A, Giannitrapani L, Soresi M. CEUS in the differential diagnosis between biliary sludge, benign lesions and malignant lesions. J Ultrasound 2018; 21:119-126. [PMID: 29476456 PMCID: PMC5972101 DOI: 10.1007/s40477-018-0286-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/30/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Conventional grayscale ultrasound (US) is accurate in the diagnosis of gallbladder disease (GD), but in some cases, it is not decisive. Contrast-enhanced ultrasound (CEUS) improves the diagnostic accuracy of US. The primary objective of this study is to assess the reliability of CEUS in the diagnosis of sludge; the secondary objective is to assess the ability of CEUS to diagnose cancer. METHODS We retrospectively reviewed the US of 4137 patients positive for GD. In 43/4137 (1.04%), the use of could not discriminate between sludge and neoplasms. Then, we evaluated CEUS in only 39 of these patients, and in 4/43 (9%) cases it was not performable. After CEUS, the absence of enhancement was considered diagnostic for sludge, while contrast washout within 60 s diagnosed malignant lesions. RESULTS Among the 39 patients, 16 had biliary sludge and 23 had lesions of the gallbladder wall; 9 of these were carcinomas and 14 were benign tumors. The absence of enhancement was present in 16/16 patients with sludge and in 0/23 patients with lesions of the gallbladder (sensitivity and specificity 100%). Washout was within 60 s in 9/9 gallbladder carcinomas and 2/14 benign lesions (sensitivity 100%; specificity 85%). CONCLUSIONS US is confirmed to be accurate in the diagnosis of GD. In doubtful cases, CEUS is very accurate in biliary sludge diagnosis. An intralesional washout at 60 s is a pattern of malignancy that can orient towards a correct diagnosis, but it is limited by the presence of false positive results, especially for smaller lesions.
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Affiliation(s)
- Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Felicani
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Mazzotta
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Veronica Gabusi
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valentina Grasso
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonio De Cinque
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lydia Giannitrapani
- Division of Internal Medicine, Biomedical Department of Internal Medicine and Specialties (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Maurizio Soresi
- Division of Internal Medicine, Biomedical Department of Internal Medicine and Specialties (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy.
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Ramaswamy A, Ostwal V, Dsouza S, Patkar S, Lewis S, Goel M, Khobragade K. Current management strategies in gallbladder cancers. CANCER RESEARCH, STATISTICS, AND TREATMENT 2018; 1:2. [DOI: 10.4103/crst.crst_4_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2025] Open
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22
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Ng YA, Tan QT, Wan WK, Goh YC. A case report of wound site seeding following cholecystectomy for dysplastic gallbladder. Int J Surg Case Rep 2017; 35:87-93. [PMID: 28502483 PMCID: PMC5985247 DOI: 10.1016/j.ijscr.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 04/09/2017] [Accepted: 04/12/2017] [Indexed: 01/26/2023] Open
Abstract
Wound site metastasis following cholecystectomy is an uncommon but well recognised complication following laparoscopic surgery for unsuspected gallbladder carcinoma. We describe a case of implantation of dysplastic cells with subsequent malignant transformation at the incision site 3 years post-cholecystectomy for an inflamed gallbladder. Histopathological examination of this tumour confirmed adenocarcinoma of pancreatobiliary origin, possibly secondary to gallbladder cells implantation and subsequent carcinomatous change. Unlike previously reported cases, the present case has two unique features: Firstly, the histology of the resected gallbladder at the initial operation was that of a low-grade dysplasia and not carcinoma; and secondly, there was a long interval between initial surgery and subsequent development of the wound site tumour. This case highlights that careful handling of the specimen tissue intraoperatively is paramount as cells implanted in the wound site can survive and undergo malignant transformation. All new masses occurring along the surgical wound site should be followed up and investigated to exclude implanted tumours.
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Affiliation(s)
- Y Annalisa Ng
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore.
| | - Qing Ting Tan
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore
| | - Wei Keat Wan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Yaw Chong Goh
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore
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Krishnatreya M, Kataki AC. Randomized-Control Screening Trials to Lower Gall Bladder Cancer Mortality in High Risk Populations. Asian Pac J Cancer Prev 2016; 17:2325-7. [DOI: 10.7314/apjcp.2016.17.4.2325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mellnick VM, Menias CO, Sandrasegaran K, Hara AK, Kielar AZ, Brunt EM, Doyle MBM, Dahiya N, Elsayes KM. Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics 2016; 35:387-99. [PMID: 25763724 DOI: 10.1148/rg.352140095] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gallbladder polyps are seen on as many as 7% of gallbladder ultrasonographic images. The differential diagnosis for a polypoid gallbladder mass is wide and includes pseudotumors, as well as benign and malignant tumors. Tumefactive sludge may be mistaken for a gallbladder polyp. Pseudotumors include cholesterol polyps, adenomyomatosis, and inflammatory polyps, and they occur in that order of frequency. The most common benign and malignant tumors are adenomas and primary adenocarcinoma, respectively. Polyp size, shape, and other ancillary imaging findings, such as a wide base, wall thickening, and coexistent gallstones, are pertinent items to report when gallbladder polyps are discovered. These findings, as well as patient age and risk factors for gallbladder cancer, guide clinical decision making. Symptomatic polyps without other cause for symptoms, an age over 50 years, and the presence of gallstones are generally considered indications for cholecystectomy. Incidentally noted pedunculated polyps smaller than 5 mm generally do not require follow-up. Polyps that are 6-10 mm require follow-up, although neither the frequency nor the length of follow-up has been established. Polyps that are larger than 10 mm are typically excised, although lower size thresholds for cholecystectomy may be considered for patients with increased risk for gallbladder carcinoma, such as patients with primary sclerosing cholangitis.
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Affiliation(s)
- Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (V.M.M.), Department of Pathology (E.M.B.), and Department of Surgery (M.B.M.D.),Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H., N.D.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (A.Z.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, Coimbra FJF, Jarnagin WR. Gallbladder cancer: expert consensus statement. HPB (Oxford) 2015; 17:681-90. [PMID: 26172135 PMCID: PMC4527853 DOI: 10.1111/hpb.12444] [Citation(s) in RCA: 316] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled. Provided the patient is medically fit for surgery, data support the resection of all gallbladder polyps of >1.0 cm in diameter and those with imaging evidence of vascular stalks. The minimum staging evaluation of patients with suspected or proven gallbladder cancer includes contrasted cross-sectional imaging and diagnostic laparoscopy. Adequate lymphadenectomy includes assessment of any suspicious regional nodes, evaluation of the aortocaval nodal basin, and a goal recovery of at least six nodes. Patients with confirmed metastases to N2 nodal stations do not benefit from radical resection and should receive systemic and/or palliative treatments. Primary resection of patients with early T-stage (T1b-2) disease should include en bloc resection of adjacent liver parenchyma. Patients with T1b, T2 or T3 disease that is incidentally identified in a cholecystectomy specimen should undergo re-resection unless this is contraindicated by advanced disease or poor performance status. Re-resection should include complete portal lymphadenectomy and bile duct resection only when needed to achieve a negative margin (R0) resection. Patients with preoperatively staged T3 or T4 N1 disease should be considered for clinical trials of neoadjuvant chemotherapy. Following R0 resection of T2-4 disease in N1 gallbladder cancer, patients should be considered for adjuvant systemic chemotherapy and/or chemoradiotherapy.
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Affiliation(s)
- Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA,Correspondence Thomas A. Aloia, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030, USA. Tel: + 1 713 563 0189. Fax: + 1 713 745 1921. E-mail:
| | - Nicolas Járufe
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Católica de Chile)Santiago, Chile
| | - Milind Javle
- Department of GI Medical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Juan C Roa
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Catolica de Chile)Santiago, Chile
| | - Volkan Adsay
- Department of Pathology and Laboratory Medicine, Winship Cancer InstituteEmory University, Atlanta, GA, USA
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer CentreSão Paulo, Brazil
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
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Gupta R, Singh M, Karmakar S, Karmakar S. Gallbladder cancer presenting with brain and bone metastasis: case report. J Clin Diagn Res 2015; 9:PD01-2. [PMID: 25954661 DOI: 10.7860/jcdr/2015/11802.5670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/20/2015] [Indexed: 11/24/2022]
Abstract
Although gallbladder cancer is a rare disease worldwide, north India has one of the highest incidences of this disease. We report a case of asymptomatic gall bladder cancer with brain metastasis. The patient presented with a scalp lump as the sole presenting feature, with no symptoms attributable to abdominal malignancy. Previously, the lump had been incised by a local practitioner who had probably misdiagnosed it as an abscess.
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Affiliation(s)
- Raghvendra Gupta
- Lecturer, Department of Surgery, G.S.V.M. Medical College , Kanpur, India
| | - Manish Singh
- Lecturer, Department of Surgery, G.S.V.M. Medical College , Kanpur, India
| | - Shilpi Karmakar
- Junior Resident, Department of Surgery, G.S.V.M. Medical College , Kanpur, India
| | - Saurabh Karmakar
- Assistant Professor, Department of Pulmonary Medicine, Era's Lucknow Medical College , Lucknow, India
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Dwivedi AND, Jain S, Dixit R. Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread. World J Clin Cases 2015; 3:231-244. [PMID: 25789296 PMCID: PMC4360495 DOI: 10.12998/wjcc.v3.i3.231] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/21/2014] [Accepted: 12/16/2014] [Indexed: 02/05/2023] Open
Abstract
The most common malignancy of biliary tract is gallbladder cancer (GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a very poor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is based on the gender, geography and ethnicity which suggest that both genetic and environmental factors can cause GBC. The major route of spread of gallbladder cancer (GC) is loco-regional rather than distant. It spreads by lymphatic, vascular, neural, intraperitoneal, and intraductal routes. Sonography is usually the most common imaging test to evaluate symptoms of biliary tract disease including suspected GC. With recent advances in imaging modalities like multi-detector computed tomography (CT) scanners, magnetic resonance imaging-positron emission tomography/CT diagnosis of gallbladder cancer has improved. Studies have also targeted molecular and genetic pathways. Treatment options have included extended and radical surgeries and adjuvant chemotherapy. This review article deals in detail with important aspects of carcinoma gallbladder and its manifestations and challenges. Role of various imaging modalities in characterization and accurate staging has been discussed. The loco-regional spread of this aggressive malignancy is dealt explicitly.
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Steller J, Russell B, Lotfipour S, Maldonado G, Siepel T, Jakle H, Hata S, Chiem A, Fox JC. USEFUL: Ultrasound Exam for Underlying Lesions incorporated into physical exam. West J Emerg Med 2014; 15:260-6. [PMID: 24868302 PMCID: PMC4025521 DOI: 10.5811/westjem.2013.8.19080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 08/27/2013] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training. METHODS Medical students with ranging levels of ultrasound training received a 25-minute presentation on our USEFUL followed by a 30-minute hands-on session. Following the hands-on session, the students were asked to perform a timed USEFUL on 2-3 standardized subjects. All images were documented as normal or abnormal with the understanding that an official detailed exam would be performed if an abnormality were to be found. All images were read and deemed adequate by board eligible emergency medicine ultrasound fellows. RESULTS Twenty-six exams were performed by 9 students. The average time spent by all students per USEFUL was 11 minutes and 19 seconds. Students who had received the University of California, Irvine School of Medicine's integrated ultrasound curriculum performed the USEFUL significantly faster (p< 0.0025). The time it took to complete the USEFUL ranged from 6 minutes and 32 seconds to 17 minutes, and improvement was seen with each USEFUL performed. The average time to complete the USEFUL on the first standardized patient was 13 minutes and 20 seconds, while 11 minutes and 2 seconds, and 9 minutes and 20 seconds were spent performing the exam on the second and third patient, respectively. CONCLUSION Students were able to effectively complete all scans required by the USEFUL in a timely manner. Students who have been a part of the integrated ultrasound in medicine curriculum performed the USEFUL significantly faster than students who had not. Students were able to significantly improve upon the time it took them to complete the USEFUL with successive attempts. Future endpoints are aimed at assessing the feasibility and outcomes of an ultrasound-assisted physical exam in a primary care setting and the exam's effect on doctor-patient satisfaction. [West J Emerg Med. 2014;15(3):260-266.].
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Affiliation(s)
- Jon Steller
- University of California, Irvine School of Medicine, Irvine, California
| | - Bianca Russell
- University of California, Irvine School of Medicine, Irvine, California
| | - Shahram Lotfipour
- University of California, Irvine School of Medicine, Irvine, California
- Department of Emergency Medicine, University of California, Irvine, Orange, California
| | | | - Tim Siepel
- Department of Family Medicine, State University of New York, Buffalo, New York
| | - Halsey Jakle
- University of California, Irvine School of Medicine, Irvine, California
| | - Stacy Hata
- University of California, Irvine School of Medicine, Irvine, California
| | - Alan Chiem
- University of California, Olive View-University of California, Los Angeles Medical Center, Sylmar, California
| | - John Christian Fox
- University of California, Irvine School of Medicine, Irvine, California
- Department of Emergency Medicine, University of California, Irvine, Orange, California
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Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract- an update. Cancer Imaging 2014; 14:14. [PMID: 25608662 PMCID: PMC4331820 DOI: 10.1186/1470-7330-14-14] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 12/13/2022] Open
Abstract
Malignancies of the biliary tract include cholangiocarcinoma, gallbladder cancers and carcinoma of the ampulla of Vater. Biliary tract adenocarcinomas are the second most common primary hepatobiliary cancer. Due to their slow growing nature, non-specific and late symptomatology, these malignancies are often diagnosed in advanced stages with poor prognosis. Apart from incidental discovery of gall bladder carcinoma upon cholecystectomy, early stage biliary tract cancers are now detected with computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). Accurate characterization and staging of these indolent cancers will determine outcome as majority of the patients' are inoperable at the time of presentation. Ultrasound is useful for initial evaluation of the biliary tract and gallbladder masses and in determining the next suitable modality for further evaluation. Multimodality imaging plays an integral role in the management of the biliary tract malignancies. The imaging techniques most useful are MRI with MRCP, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and positron emission tomography (PET). In this review we will discuss epidemiology and the role of imaging in detection, characterization and management of the biliary tract malignancies under the three broad categories of cholangiocarcinomas (intra- and extrahepatic), gallbladder cancers and ampullary carcinomas.
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Affiliation(s)
- Tiffany Priyanthi Hennedige
- Department of Diagnostic Imaging, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Wee Thong Neo
- Department of Diagnostic Imaging, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
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Wright GP, Siripong A, Winton MD, Mitchell EJ, Goslin BJ, Chung MH. Selective laparoscopic approach in suspected gallbladder malignancy. JSLS 2014; 17:596-601. [PMID: 24398202 PMCID: PMC3866064 DOI: 10.4293/108680813x13693422519352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
More than half of patients in this study with findings concerning for gallbladder malignancy were found to have benign disease, suggesting that an initial laparoscopic approach may be appropriate in selected patients. Background and Objectives: We examined patients with clinical findings that are concerning for gallbladder malignancy to determine the incidence of pathology-confirmed malignancy and to discover factors that may be used to determine which patients may be initially treated with a laparoscopic approach. Methods: All patients referred to a surgical oncologist with preoperative findings that are concerning for gallbladder malignancy who had not undergone previous surgical resection from 2005 to 2011 were reviewed. Variables collected included demographics, imaging, operative findings, and final pathology. Patients were grouped into 3 categories based on preoperative findings: gallbladder mass, irregular wall thickening, and abnormal intraoperative findings on previous diagnostic laparoscopy. Results: Twenty-nine of 4474 patients evaluated for gallbladder pathology during the study period met the inclusion criteria. Preoperative imaging included computed tomography, ultrasonography, and magnetic resonance imaging. Twelve patients had multiple imaging studies. Eight patients were initially treated with a laparoscopic approach with 3 conversions to an open procedure. Forty-eight percent of patients had pathology-confirmed malignancy. Patients without a discrete mass on imaging were more likely to have benign disease (P = .04). Conclusions: Our results demonstrate that >50% of patients with suspicious preoperative findings had benign pathology, suggesting that the initial laparoscopic approach in selected patients may be appropriate.
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Affiliation(s)
- G Paul Wright
- Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, 1000 Monroe NW, Grand Rapids, MI 49503, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Arida Siripong
- Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Michael D Winton
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Eric J Mitchell
- Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Brent J Goslin
- Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Mathew H Chung
- Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA, Spectrum Health Medical Group, Grand Rapids, MI, USA
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Ramos-Font C, Gómez-Rio M, Rodríguez-Fernández A, Jiménez-Heffernan A, Sánchez Sánchez R, Llamas-Elvira JM. Ability of FDG-PET/CT in the detection of gallbladder cancer. J Surg Oncol 2013; 109:218-24. [PMID: 24165875 DOI: 10.1002/jso.23476] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/03/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the value of FDG-PET/CT in the evaluation of gallbladder carcinomas (GBC). METHODS A prospective cohort of patients with suspicion of or confirmed GBC was studied with FDG-PET/CT. Diagnostic accuracy parameters were calculated in comparison with pathology and/or the clinical course of patients. Clinical impact of PET/CT imaging was estimated. RESULTS Forty-nine patients were enrolled (34 malignant tumors, 15 benign lesions; 37 staging, 12 restaging). Overall diagnostic accuracy was 95.9% for the diagnosis of the primary lesion, 85.7% for lymph node involvement and 95.9% for metastatic disease. Mean SUVmax in malignant gallbladder lesions was 7.92 ± 6.25 Analysis of ROC curves showed a SUVmax cut-off value of 3.62 for malignancy (S: 78.1%; Sp: 88.2%). Diagnostic accuracy in the restaging group reached 100%. FDG-PET/CT changed the management of 22.4% of the population. COMMENTS Diagnosis of malignancy or benignity of suspicious gallbladder lesions is accurately made with FDG PET/CT, allowing a precise staging of GBC due to its ability to identify unsuspected metastatic disease. SUVmax has a complementary role in addition to visual analysis.
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Affiliation(s)
- Carlos Ramos-Font
- Nuclear Medicine Department, UGC Diagnóstico por la Imagen, Juan Ramón Jiménez Hospital, Huelva, Spain
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Swank HA, Mulder IM, Hop WC, van de Vijver MJ, Lange JF, Bemelman WA. Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: a systematic review. Surg Endosc 2013; 27:4439-48. [PMID: 23877761 DOI: 10.1007/s00464-013-3084-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/24/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine histopathological examination of gallbladder specimens is mainly performed to identify unexpected gallbladder carcinoma (GBC). This systematic review assesses the prevalence and characteristics of GBC in cholecystectomy specimens. METHODS PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for all articles reporting on the finding of GBC in cholecystectomy specimens. RESULTS Of the 30 articles included, 20 were from Europe and the United States, and 10 were of Asian origin. In the Western studies, 276 cases of GBC were found in 61,542 specimens (median prevalence 0.4%, 95% confidence interval [CI] 0.3-0.6). Of these, 65% were expected pre- or intraoperatively. In the Asian studies, 344 cases of GBC were found in 37,365 specimens (median prevalence 1.2%, 95% CI 0.8-1.7). Of these, 45% were expected pre- or intraoperatively. In a subgroup analysis, identification of previously unexpected GBC affected treatment in only a minority of patients. In total, 72% of the patients received no further treatment and 32 patients (22%) received secondary surgery, of whom 15 patients survived at least 1 year. CONCLUSIONS The histopathological finding of GBC after cholecystectomy appears to be a rare event. The prevalence of unexpected GBC was higher in Asian studies than in Western studies. The pre- and intraoperative sensitivity for this carcinoma is low. Moreover, the diagnosis of GBC at the time of histopathology is usually inconsequential. The results of this systematic review do not support routine histopathology of cholecystectomy specimens in clinical practice.
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Affiliation(s)
- Hilko A Swank
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands,
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Mario Uribe M, Clauio Heine T, Freddy Brito M, Diana Bravo L. Actualización en cáncer de vesícula biliar. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70202-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Anderson MA, Appalaneni V, Ben-Menachem T, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fisher LR, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan K, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc 2013; 77:167-74. [PMID: 23219047 DOI: 10.1016/j.gie.2012.09.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 02/08/2023]
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Andrén-Sandberg A. Diagnosis and management of gallbladder cancer. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:293-9. [PMID: 22866265 PMCID: PMC3409652 DOI: 10.4103/1947-2714.98586] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gallbladder cancer (GBC) is a rather uncommon disease, but at the time when it gives symptoms it has usually reached no longer curable stage. Therefore, all attempts must be made to make the diagnosis earlier to have better opportunity for cure. The author searched PubMed, and reviewed literatures on diagnoses and treatment of GBC.
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Affiliation(s)
- Ake Andrén-Sandberg
- Department of Surgery, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden
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36
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Invasion of the hepatic artery is a crucial predictor of poor outcomes in gallbladder carcinoma. World J Surg 2012; 36:645-50. [PMID: 22270983 DOI: 10.1007/s00268-011-1413-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the present study we undertook a retrospective analysis of gallbladder carcinoma to assess whether histologically determined hepatic artery (HA) invasion and portal vein (PV) invasion can be considered prognostic factors. METHODS Seventy-one patients who had undergone radical resection for gallbladder carcinoma between 1995 and 2008 at University of Tsukuba were selected from the database for analysis. Patients who required extended surgery for para-aortic lymph node metastasis were also included. Correlation between invasion of the HA and the PV and prognosis and other clinicopathologic factors were analyzed. RESULTS There were two postoperative deaths among the 71 patients. Pathological invasion of the HA was confirmed in 16 (22.5%) cases and PV invasion was confirmed in 15 patients. Patients with invasion of the HA had a significantly poorer prognosis than those without HA invasion (P < 0.0001). Additionally, in univariate analysis, gender (male), positive para-aortic lymph node metastasis, PV invasion, and HA invasion were identified as significant poor prognostic factors. In multivariate analysis, only HA invasion was an independent prognostic factor (Odds Ratio 0.323; P = 0.029). CONCLUSIONS Invasion of the HA is a crucial prognostic factor in patients with gallbladder carcinoma.
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Abstract
Gallbladder cancer (GBC) is the leading cause of cancer related mortality in certain geographic areas. Most of the patients with GBC have advanced disease at presentation, precluding curative resection resulting in a dismal prognosis. However, recent advances in the understanding of its epidemiology and pathogenesis coupled with development of newer diagnostic tools and therapeutic options, has resulted in enhanced optimism towards the management of the disease. The leading risk factors are gallstones, advancing age, female gender, anomalous pancreaticobiliary ductal junction, certain ethnic groups and geographic populations. Advances in radiological imaging and the advent of endoscopic ultrasound have facilitated early detection and accurate staging of the tumor. A high index of suspicion in high risk groups is necessary to pick up incidental and early GBC, as surgical resection is curative. In patients with suspected GBC, an open surgical resection that is appropriate for that stage is advocated. Adjuvant combination chemotherapy and molecular targeted therapy are emerging as effective therapeutic options in those with advanced GBC. Endoscopic palliation of biliary and gastric outlet obstruction with metallic stents has improved their quality of life. Prevention remains the hitherto less explored option to reduce GBC related mortality. Prophylactic cholecystectomy in high risk groups is a cost-effective option. A multi-disciplinary systematic global approach to initiate collaborative ventures to understand epidemiology, standardize management strategies, conduct multi-centric trials with newer therapeutic agents and initiate preventive measures, would pave way for the future conquest of the disease.
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Affiliation(s)
- Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Siegel AB, Sheynzon V, Samstein B. Uncommon Hepatobiliary Tumors. TEXTBOOK OF UNCOMMON CANCER 2012:423-440. [DOI: 10.1002/9781118464557.ch30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Zhang Z, Wang X, Wu W, Wang J, Wang Y, Wu X, Fei X, Li S, Zhang J, Dong P, Gu J, Liu Y. Effects of matrine on proliferation and apoptosis in gallbladder carcinoma cells (GBC-SD). Phytother Res 2011; 26:932-7. [PMID: 22162124 DOI: 10.1002/ptr.3657] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 08/14/2011] [Accepted: 08/23/2011] [Indexed: 12/29/2022]
Abstract
Although matrine, a primary active component of dried Sophora flavescens root (ku shen), is known to induce apoptosis in a variety of tumor cells in vitro, the molecular mechanism of such apoptosis remains elusive. This analysis of the cell cycle and apoptosis in matrine-treated human gallbladder carcinoma cells (GBC-SD) showed that matrine can indeed inhibit cell proliferation and induce G1 cell cycle arrest and apoptosis in a dose- and time-dependent manner. An additional western blot analysis of matrine-treated cells also showed caspase-3 and Bcl-2 activation, as well as cyclinE down-regulation. Overall, the results indicate that matrine perturbs gallbladder cancer cell progression during the G1 phase by down-regulating cyclinE and induces apoptosis by decreasing the expression of the antiapoptotic protein Bcl-2 and increasing expression of the proapoptotic protein Bax.
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Affiliation(s)
- Zhiping Zhang
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China
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Ramos-Font C, Gómez Río M, Rodríguez-Fernández A, Sánchez Sánchez R, Llamas Elvira J. Positron tomography with 18F-fluorodeoxyglucose in the preoperative evaluation of gallbladder lesions suspicious of malignancy: Diagnostic utility and clinical impact. REVISTA ESPAÑOLA DE MEDICINA NUCLEAR (ENGLISH EDITION) 2011; 30:267-275. [DOI: 10.1016/j.remngl.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Le MD, Henson D, Young H, Albores-Saavedra J. Is gallbladder cancer decreasing in view of increasing laparoscopic cholecystectomy? Ann Hepatol 2011. [PMID: 21677332 DOI: 10.1016/s1665-2681(19)31542-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- My Di Le
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC, USA
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42
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Ramos-Font C, Gómez Río M, Rodríguez-Fernández A, Sánchez Sánchez R, Llamas Elvira JM. [Positron tomography with 18F-fluorodeoxyglucose in the preoperative evaluation of gall bladder lesions suspicious of malignancy. Diagnostic utility and clinical impact]. ACTA ACUST UNITED AC 2011; 30:267-75. [PMID: 21612846 DOI: 10.1016/j.remn.2011.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 02/02/2011] [Accepted: 02/07/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Gallbladder carcinoma is a neoplasm having a poor prognosis in which the role of the positron emission tomography with (18)F-fluordeoxyglucose as a diagnostic tool, although of possible usefulness, has not been well-defined. METHODS/DESIGN It is a prospective cohort of patients with radiologically malignant suspicious gallbladder lesions. A staging diagnostic presurgical FDG-PET study was carried out in each patient using both dedicated PET and multimodality PET-CT scanners. Diagnostic accuracy parameters were calculated from the results of PET imaging and were correlated with the condition and/or the clinical course of the patients. The clinical impact of its implementation in the diagnosis of gallbladder carcinoma was also analyzed. RESULTS A total of 42 patients were recruited (22 malignant lesions, 20 benign). Overall diagnostic accuracy was 83.33% for the diagnosis of the primary lesion, 88.89% for the evaluation of lymph node involvement and 85.1% for the evaluation of metastatic disease. Mean SUVmax in malignant gallbladder lesions was 6.14±2.89. ROC curve showed a cut-off value of 3.65 in the SUVmax for malignancy. Accuracy of PET studies alone (n=21) was slightly lower than that of the PET/CT (n=21). FDG-PET changed the management of 14.8% of the population due to the identification of unsuspected metastatic disease. COMMENTS FDG-PET accurately diagnoses malignancy or benignity of suspicious gallbladder lesions, with the addition of its capacity to identify unsuspected metastatic disease. PET-CT improves the diagnostic accuracy of the procedure, due to the metabolic-structural complementarity of their information. The SUVmax has a complementary value added to the visual analysis.
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Affiliation(s)
- C Ramos-Font
- Servicio de Medicina Nuclear, Hospital Juan Ramón Jiménez, Huelva, España.
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Suzuki K, Watada S, Yoko M, Nakahara T, Kumamoto Y. Successful Diagnosis of Gallbladder Carcinoma Coexisting with Adenomyomatosis by 18F-FDG-PET—Report of a Case. J Gastrointest Cancer 2010; 42:252-6. [PMID: 20949377 DOI: 10.1007/s12029-010-9221-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Improving the Preoperative Diagnostic Yield of Gallbladder Cancers. Ann Surg 2010. [DOI: 10.1097/sla.0b013e3181f07e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Andreano A, Laeseke P, Lava M, Zimbaro F, Daniela V, Meloni MF. Asymptomatic metastatic melanoma of the gallbladder diagnosed with contrast-enhanced ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1133-1137. [PMID: 20587437 DOI: 10.7863/jum.2010.29.7.1133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Anita Andreano
- Department of Radiology, University of Milan-Bicocca, 33 Pergolesi St, 20052 Monza, Italy.
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Is there a role for cholecystectomy in gallbladder carcinoma discovered to be unresectable for cure at laparotomy? World J Surg 2009; 32:2683-7. [PMID: 18836852 DOI: 10.1007/s00268-008-9763-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Palliative operative resection in patients with locally advanced cancer of the gallbladder (GBC) found not to be amenable to radical resection for cure at exploration has received little attention. This article evaluates the benefits, if any, of cholecystectomy with biliary drainage in such patients. METHODS Available records of locally advanced but nonmetastatic GBC patients treated in the Department of Surgical Oncology, B.H.U., Varanasi, India, during the last 8 years were retrospectively reviewed. Of these, 30 patients (group I) with GBC (T(3-4),N(0-1),M(0)) treated with cholecystectomy +/- biliary bypass were selected and compared with equal number of controls matched for age (+/-5 years), sex, histopathology, stage, residence, and postoperative chemotherapy who underwent biopsy +/- biliary bypass only (group II) followed by chemotherapy during the same period. Survival rates were calculated by using Kaplan-Meier curves. Follow-up ranged from 1-15 months. RESULTS The median survival was 7 and 2 months for groups I and II (P < 0.0001), respectively. The 30-day postoperative mortality and morbidity was 3% vs. 12% and 13% vs. 16% in groups I and II, respectively. CONCLUSIONS Results suggest that a better median survival can be achieved after cholecystectomy in locally advanced unresectable GBC compared with only bypass and biopsy procedures. These findings may justify a palliative cholecystectomy in selected patients with locally advanced GBC.
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Ramos-Font C, Santiago Chinchilla A, Rodríguez-Fernández A, Rebollo Aguirre Á, Gómez Río M, Llamas Elvira J. Estadificación del cáncer de vesícula mediante tomografía de positrones con 18F-fluorodesoxiglucosa. ACTA ACUST UNITED AC 2009; 28:74-7. [PMID: 19406053 DOI: 10.1016/s0212-6982(09)70701-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Park JY, Hong SP, Kim YJ, Kim HJ, Kim HM, Cho JH, Park SW, Song SY, Chung JB, Bang S. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol 2009; 24:219-22. [PMID: 19054258 DOI: 10.1111/j.1440-1746.2008.05689.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The management of gallbladder polyps (GBP) is directly linked to the early diagnosis of gallbladder cancer (GBC). This study aimed to evaluate the malignant risk of GBP. METHODS In total, 1558 patients diagnosed with GBP were followed. Neoplastic polyps were defined as GBC and its premalignant lesions. The risk for malignancy was estimated with the cumulative detection rate of neoplastic polyps. RESULTS Thirty-three cases (2.1%) were diagnosed with neoplastic polyps. The cumulative detection rates of neoplastic polyps were 1.7% at 1 year, 2.8% at 5 years, and 4% at 8 years after diagnosis. The size of GBP and the presence of gallstones were risk factors for neoplastic polyps. Polyps > or = 10 mm had a 24.2 times greater risk of malignancy than polyps < 10 mm. However, 15 of 33 neoplastic polyps (45.5%) were < 10 mm at the time of diagnosis of GBP. During follow up in 36 (3.5%) of 1027 cases, an increase in size was detected; of these, nine (25%) had neoplastic polyps. CONCLUSION Even small polyps have a risk of malignancy, and careful long-term follow up of GBP will help detect and treat early GBC.
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Affiliation(s)
- Jeong Youp Park
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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