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