담낭암의 병리 육안적 형태, 병기에 따른 생존 분석 및 임상적 고찰

Abstract

Background/Aims: The gallbladder cancer shows highly malignant potential and very poor prognosis. Most of patients who have gallbladder cancer are asymptomatic and have far advanced stage when it was diagnosed. Recently early detection rate of gallbladder disease was increased by common use of screening ultrasonography. For the patients with early staged cancer, we can achieve cure of the disease even with laparoscopic cholecystectomy. Instead, for the patients with advanced stage of gallbladder cancer, extended surgery is required for increased survival rate. Methods: The authors analyzed the clinical manifestation, diagnosis, therapeutic modality and survival rate for the patients of gallbladder cancer who were treated with surgical resection. From 1993 to 2001, we analysed 55 patients who had gallbladder cancer that was proven pathologically. Results: The mean age of 55 patients was 62.6 years old. The clinical manifestations were RUQ abdominal pain (50.9%), jaundice (12.7%), anorexia (10.9%), epigastric discomfort, palpable mass, ascites and so on. Seven (12.7%) of the patients were asymptomatic. For diagnostic modalities, untrasonography was used for all of the patients, abdominal CT, MRI and ERCP were used selectively. Among 55 patients, 18 patients were diagnosed as benign lesion preoperatively. The sensitivity rate of detecting malignancy was 67.3%. The operative procedure included laparoscopic cholecystectomy, open cholecystectomy, cholecystectomy with regional lymph node dissection, cholecystectomy with combined hepatectomy and hepatopancreatoduodenectomy (HPD). Pathologic findings showed infiltrating type in 27 patients (49.1%) and fungating type in 28 patients (50.1%). Three and five year survival rate of each type were 39.8%, 14.2% and 62.1%, 48.3%. Three and five year survival rates of patients who had negative lymph nodes metastasis were 60.7% and 23.2%, instead positive lymph nodes metastasis were 18.3% and 0%. Conclusion: In order to get better survival rate of the patients with gallbladder cancer, early detection and appropriate operative procedures are important, so that minimal invasive surgery for early cancer and extended surgery for advanced stages.