Clinical features were reviewed in 80 patients with primary gallbladder cancer at Severance Hospital, College of Medicine, Yonsei University between Jan. 1981 and Dec. 1989. We reviewed these patients to investigate the clinical findings, the
accuracy
of diagnostic procedures, treatment modality, pathologic characteristics, stage and median survival of primary gallbladder cancer.
@ES The results were as follows.
@EN 1) The ratio of male to female was 1:1.9 and the mean age was 59.4 years.
2) The clinical symptoms in order of frequency were epigastric and right upper quadrant pain (90.0%), jaundice (57.5%), indigestion (47.5%) and a palpable right upper quadrant mas s(41.3%).
3) Among the coexisting disorders, biliary stones were in 30 cases (37.5%) and clonorchiasis in 6 cases (7.5%).
4) The diagnostic methods in order of diagnostic accuracy were abdominal computed tomography (85.3%), peritoneoscopy (69.2%), abdominal ultrasonography (64.7%) and ERCP (50.0%).
5) Adenocarcioma was the most common histologic diagnosis, presenting in 69 out of 74 patients (93.2%). Undifferentiated carcinoma was found in one patient each.
6) The most common site of local invasion was the liver (34.6%), followed by bile duct (32.5%), omentum (18.8%) and duoderium (12.5%). The llver was also the most common site of metastasis (36.3%), followed by regional lymph nodes (33.8%),
peritoneum
(11.3%), cervical lymph nodes (7.5%), lung (2.5%) and adrenal gland (1.4%).
7) Accordinng to TNM classification (AJCC, 1988), the lesions of 3 cases (3.7%) were in stage I, 5 cases (6.3%) in stage II, 20 cases (25.0%) in stage III and 52 cases (65.0%) in stage IV.
8) The treatment modalities were variable, surgical procedures were performed in 47 cases (58.8%), including radical resection in 7 cases (8.8%), cholecystectomy with T-tube choledochostomy in 27 cases (33.8%), tube cholecystostomy or
choledochostomy
in 5 cases (6.2%), and exploratory laparotomy in 8 cases (10.0%). Among the non-surgical treatment, PTBD was performed in 3 cases (3.8%), anticancer chemotherapy in 8 cases (10.0%) and radiotherapy with or without hyperthermia in 6cases (7.4%).
9) The total median survival was 3.7 months: the median survival of stage I was 52.9 months, stage II 17.5 months, stage III 13.8 monts and stage IV 2.6 months.
We concluded that early detection and curative resection of primary gallbladder cancer were the most important to improve the prognosis.
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