Introduction: Gallbladder cancer has a poor prognosis, with a reported 5-year survival of 5%. The prognosis improves when an R0 resection is feasible, but an early diagnosis is rare. The aim of the present study is to analyze the different conditions associated with gallbladder carcinomas and to report the main prognostic factors for these tumors to enable prevention.
Materials and methods: From 1986 to 2012, 75 patients were found to have gallbladder cancer during the study of 2942 patients affected by biliary tract diseases; 34 of these patients had gallbladder and gallstones, and had been subjected to bile analysis. Pancreatobiliary reflux was studied by biliary trypsin and C-Ki-ras genes were analyzed in 11 cases.
Results: Gallstones were found in 72 of 75 gallbladder cancer patients; in particular, large gallstones were associated with 88.88% of squamous-cell carcinoma, 68.2% of adenocarcinoma, and never with papillary adenocarcinoma. Pancreatobiliary reflux was associated with papillary adenocarcinoma in 100% of cases, but seldom with squamous cell carcinoma. C-Ki-ras mutations were found in 100% of patients with papillary carcinoma.
Discussion and conclusion: R0 resection in in-situ cancer has the best prognosis. Preventive cholecystectomy should be performed in high-risk patients (gallstones larger 3 cm; adenomatous polyps>1 cm; pancreatobiliary reflux, porcelain gallbladder, segmental adenomyomatosis, xanthogranulomatous cholecystitis). The histological stratification of gallbladder cancer should be carried out before starting further studies because squamous-cell carcinoma, adenocarcinoma, and papillary carcinoma are associated with different risk factors and genetic mutations and have different responsiveness to chemotherapies.
aGeneral Surgery, San Martino, IST, University Hospital, Genoa
bGeneral Surgery, Nuovo Policlinico Le Scotte, University of Siena, Siena, Italy
Post scriptum: This paper is dedicated to my grandmother Bianca Trombino in Bruno who died of gallbladder cancer after a 25-year-long cholesterol cholelithiasis that hampered preventive cholecystectomy.
Correspondence to Andrea Cariati, MD, Via Fratelli Coda 67/5A, 16166 Genoa, Italy Tel: +39 010 372 4909; fax: +39 010 555 6664; e-mail: firstname.lastname@example.org
Received July 11, 2013
Accepted February 5, 2014