Treatment and prognosis of primary gallbladder

By | October 29, 2011

Common treatment for gallbladder cancer include radical surgical resection, palliative surgery, radiotherapy and chemotherapy, no matter which treatment method, its efficacy is not satisfactory, and some other malignancies are also far less than treatment.
Common treatment for gallbladder cancer 1. Surgical treatment of gallbladder surgery in the treatment of currently still the preferred method, and strive for early diagnosis and excision in the surgery, but there were still difficulties in early diagnosis, the excision rate is low, Surgical treatment depends largely on the clinical stage of cancer and biological characteristics, but also with the choice of methods in surgery and surgery related to thoroughness.
Leslie 70s of the 20th century, pointed out that to carry out surgical resection of the gallbladder, the prognosis is very good, he thinks, after gallbladder symptoms in patients with an average survival time of 6 months, the average survival time after surgery was 9 months. In a group of 90 cases of gallbladder carcinoma patients, the survival time after only three cases over 5 years, accounting for 3.33%, which was due to patients with early gallbladder cancer are due to chronic cholecystitis symptoms after cholecystectomy, pathology Check occasionally found, and most patients are of advanced gallbladder cancer. Beltzhe and Condon obvious clinical symptoms of this 14 cases of gallbladder cancer patients were cholecystectomy, of which only 2 patients survived to 5 years. However, Klein and Finck is recommended that cholecystectomy due to cholelithiasis, the gallbladder should be cut, suspected cancer lesions on frozen section to do in order to have a broad basis in accordance with gallbladder removal surgery, the case of carcinoma in situ, simple cholecystectomy can be cured, such as invasive cancer have been small, should actively further surgical treatment, the case of invasive gallbladder carcinoma, surgical resection is very difficult. 80 years of the 20th century, China scholars, the excision is the only effective treatment for gallbladder cancer, but the results are disappointing, only a very small number of patients survive after surgery to 5 years. According to the patients found that 75% of patients had tumor resection may be beyond the scope of the operation, 20% of patients with cancer have been transferred to the adjacent liver tissue or liver, lymph nodes on the ligament, only 6% – 10% of patients with cancer is still confined to the gallbladder, cholecystectomy if this time, though prolong the lives of patients, but also the survival rate of only a few people up to 5 years. Another theoretically possible that some patients with liver, gallbladder and liver removal of mold-shaped ligament lymph node dissection, in the past have used the right lobe with the gallbladder surgery, but did not survive after 5 years or more cases. For more advanced disease, to expand the range of excision is not helpful, feasible palliative surgical therapies, such as the open common bile duct, the T-tube placed in one arm over the scope of obstruction to relieve symptoms of Yellow Fever and itch, but also by BTCD As a palliative treatment, without having to do laparotomy.
The 20th century, there is a group of 80 domestic gallbladder surgery reported less than 3% 5-year survival rate, foreign countries also reported a group of simple excision even in the gallbladder found in the gallbladder surgery, the postoperative cure rate is also low 5%, while the other literatures abroad a group of 4658 cases of early detection of gallbladder carcinoma, of which 3911 cases were early in the surgery, 5-year survival rate of only 3.2%. 90 years after the beginning of the 20th century, scholars that the gallbladder after cholecystectomy generally only live a year or so, and that only the right half liver resection is still not enough to do, they should do most of falciform ligament in the right liver resection, but the 5-year survival rate is still 5%, so the choice of surgical approach should be based on the staging of gallbladder carcinoma, gallbladder carcinoma of the limited film Mongolia, RMB cystic lymph node metastasis (I_II period), with simple cholecystectomy is likely to be curative purposes in patients ; for Tian, N of the gallbladder, should be implemented radical cholecystectomy, which includes all cholecystectomy, gallbladder liver bed resection and whole area of appropriate lymph nodes and lymph nodes (regional lymph nodes is the gallbladder triangle, hepatoduodenal ligament and the hepatic duct and blood vessels adjacent to the duodenum and the membrane behind the head of the lymph nodes); gallbladder bed confluence of hepatic veins by the side lobe of liver, gallbladder and lymph in subserosal Bo under the membrane communicate with each other First, convergence to the cystic duct and bile duct lymph nodes, so the II-III of the gallbladder should be performed before radical cholecystectomy is expected to improve survival.
Effect of gallbladder surgery is not ideal addition to the reasons mentioned above, but also because more than gallbladder adenocarcinoma, and adenocarcinoma of rapid development, the early local and distant organ metastasis, however, I believe that surgery on the gallbladder Treatment should adopt a positive attitude, except for early diagnosis, early surgery, the proposed scheme in determining when surgery should consider the following aspects:
gallbladder cancer before surgery has been clear who often had local surgery and distant metastasis, such patients should still be active on the surgery, more extensive resection of the lesions as much as possible, and according to the specific circumstances of the patient in surgery, while seeking to make appropriate Palliative surgery to relieve patients of yellow disease, cancer, itching and other symptoms, and to lay the foundation for improving postoperative chemotherapy.
and gallbladder were suspected before surgery, patients with suspected lesions in the frozen section should be done, according to the results of frozen section to decide on the technical program. If frozen section histology confirmed I of those dollars have to extend the scope of the operation, set on the frozen section H, Tian, N period, should be done in the same cholecystectomy falciform ligament to the right most of the liver resection and lymph node cleaning.
clear before surgery for advanced gallbladder carcinoma, namely V of the patients, because of mass beyond the common bile duct and gallbladder bed next to the lymph nodes, and distant metastasis, just do palliative surgery.
postoperatively cut lesion of gallbladder specimens detailed histopathological examination should be done on histologically proven I, E, Au of patients do not have to consider surgery, but is required on the field of lymph node dissection is again to primary surgery.
Common treatment for gallbladder cancer 2. Anticancer chemotherapy has been removed for the foci, but not complete resection with lymph node metastasis, or may be used chemotherapy drugs such as mitomycin C adjuvant therapy. Should be combined with chemotherapy in patients with physical conditions that, according to KPS scoring method correct score for each patient, and then decide the dose of chemotherapy drugs and medication time. Resection for cancer is not the line may not have considered a simple anti-cancer chemotherapy, but generally speaking no effect on chemotherapy on survival.
Common treatment for gallbladder cancer 3. Radiotherapy or surgery can be after surgery, produced by electron cyclotron electron beam dose can be given to 20-30Gy. Todorki special emphasis on N histologically confirmed gallbladder cancer patients of the importance of intraoperative radiotherapy, his data show that for such patients, surgery and radiotherapy alone while giving the effect of excision were significantly different, the 3-year survival rates were 10.1% and 0, so radiotherapy as adjuvant treatment, to improve the prognosis of patients there is a certain significance.
Common treatment for gallbladder cancer 4. Other treatment, including interventional therapy, immunotherapy, gene therapy, hyperthermia and so is still at the exploratory stage, the effect is not yet certain, pending further study and observation. Cancer Hospital, Zhongshan Medical University, using the expression of p53 adenovirus E1B gene associated with liver metastasis of gallbladder carcinoma were treated with a certain effect, but its long-term results need further study.

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