Background: Cancer of the gallbladder (GB) have bad prognosis. In the occidental countries, the rate of survival 5 years is from 5 to 38 percent. Cancer of the GB is the 51h digestive cancer, usually met on female over than 65yo. Cancer of the GB relate to chronic inflammation. Cholecystis with stones that are the main cause, occupy from 75 to 90 percent of cases. In USA, men who have stone in the biliary system and chronic inflammation, have cancer of the GB 71h time more than men who have no stone and inflammation of biliary system. Objective: The authors study the clinical manifestations and the surgical result of the GB cancer. Patients and Method: It is a poststudy of the GB cancer from July 2006 to December 2009. Result: 80 cases of GB cancer among 7456 cases of LC In the 80 cases, male 40, female 40, and middle age 55. 10 cases have gall stones, the ratio is 12.5. Group 1: 33 cases, patients have subcostal pain with fever, dyspepsy mimic as acute or chronic cholecystitis with stones in the gall bladder. The ultrasound not found abnomality, but the pathology found cancer in the wall. Group 2: they have exquise pain of subcostal or RUQ pain, with lightjaudice. At examination, the paper found a subcostal mass. The ultrasound or CT found a thick or irregularity of the gall bladder wall or a mass develop intra lumen of the gall bladder. 33 cases have LC and 47 cases, opened cholecystectomy, at the same time, the authors operate in LC 300 cases of polyp of GB with 5 cases. The cases that the LC are done have tumor confine in the GB, and no lymph nodes. The cases that cancer develop out of the GB wall are extended removal of the GB, in opened cholecystectomy: 4, cholecystectomy - CBD drainage
29, cholecystectomy - hepatectomy: 6, cholecystectomy - CBD removal, with biliary anastomosis
2, cholecystectomy - CBD removal, biliari-enterotomy anastomosis
3, cholecystectomy - gastrointestinal anastomosis: 3. removal of lymph nodes. There are 42 cases stayed in hospital over 10 days. 1 case died in hospital for 351h days, 72 yo, due to fistula, cirrhosis and debility. In the follow-up during 2 years, the 33 cases Tl, 85 percent is still alive. The cases of extended cholecystectomy (47 cases)
45 percent is still alive, but there are 18 cases came back to hospital because of stenosis of bile tract or small bowel, they must be reoperated. Almost cases have chemotherapy with 5 FU and cisplatinum. Discussion: Cancer of the GB has the rate over 1 percent (80 cases/7456 cases removal of the GB). That rate is the same in comparison with the other countries as in USA
that is 1 percent for the cases of elective cholecystectomy. The diagnosis is difficult in early case. On ultrasound or on CT scan, the cystic wall is localized thick and irregularity, the biopsy make the diagnosis. When the tumor advanced, it is papable in RUQ. It invases the liver, obstructs the CBD and other organs. The operative technique base on T When the tumor is T1, no nodes, cholecystectomy is radical cure, In hospital, the authors performed the LC. If the tumors is T2, the authors turn to open and extended cholecytectomy, removal of lymph nodes and bilioenteric anastomosis. Conclusion: Cancer of the GB is a severe disease. As, clinical manifestations, the syndrom is mimic a chronic or acute cholecystitis, except the advanced case that the tumor is in the subcostal area. The authors perform the LC for the early cases (TI). In advanced cases, LC causes seeding the cancer cell. So when we found tumor that is T2, the opened cholecystectomy is mandatory, removal nodes, removal the extended viscera and anastomosis. The prognosis is bad in these cases.