Even with advanced diagnostic techniques, diagnosis of primary gallbladder cancer is difficult and is most commonly made at the time of laparotomy for presumed for presumed cholecystitis. Recently, after the aggresive surgery and adjurvant
therapy
of
advanced disease, improved survival was reported. The records of 50 patients with histologically proved gallbladder carcinoma seen at Presbyterian Medical Center between 1980 and 1994, were reviewed. Mean age was 58.8 years and 60% were female.
The
clinical manifestation in order of frequency were right upper quadrant pain and tenderness982%), fever and chills(50%), jaundice (24%), nausea and vomiting (24%), palpable abdominal mass(24%) and weight loss(10%). Forty-four percent of the cases
had
gallstones. 6% were infested with Clonorchis sinensis, 4% were liver cirrhosis and choledochal cyst were present in 2%. Adenocarcinoma was the most common pathologic type. About 67% of GB cancers are correctly diagnosed preoperatively by CT and
33%
by
ultrasonography. Three-year survivals by the AJCC(1992) staging system were 100% in stage I, 83% in stage II, 13% in stage III and 3.8% in stage IV. The site of metastasis were the regional lymph node(36%), liver(30%), porta hepatis(26%),
pancreas(10%),
omentum(6%), colon(6%), neck nodes(6%) and duodenum(2%). Surgery was performed with simple cholecystectomy in 19 of 35 resectable cases, cholecystectomy with regional lymphadectomy in 2, cholecystectomy with regional lymphadectomy and hepatic
wedge
resection in 2, cholecystectomy with Roux-en-Y choledochojejunostomy in 1, cholecystectomy with Roux-en-Y hepaticojejunostomy in 1 and palliative resection in 10. Adjuvant therapy was done with chemotherapy(mostly 5-Fluorouracil based) in 11
cases,
radiotherapy(mean total dose of 4335cGy) in 16 and chemoradiotherapy(mostly 5-Fluorouracil based regimen and a mean total dose of 3773cGy) in 6. Median survival in stage III and IV was, respectively, 7 and 1 months in non-adjuvant therapy,
8.5(alive in
all) and 4 months in chemotherapy, 17 and 6 months in radiotherapy and 18(alive in 2 of 3 cases) and 10 months in chemoradiotherapy.
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