Post on 14-Apr-2018
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Gallbladder Cancer
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Epidemiology
Incidence ~ 5000
5th most common GI malignancy
Women > men High incidence in S America (Chile)
~ 1% of pts undergoing cholecystectomy
for symptomatic gallstones
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Risk Factors
Gallstones
Gallbladder Polyps
Chronic Salmonella infection Abnormal Pancreaticobiliary duct junction
* Porcelain gallbladder* Age
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Presentation/Diagnostic Imaging
Presentation is non-specific
Diagnositic Imaging Sono
CT
MR/MRCP EUS
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Histology / Pathology
* Progression to Ca may take up to 15 yrs
Adenocarcinoma 80-90% Anaplastic 7%
Squamus 6%
Lymphoma, Sarcoma
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Staging
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Surgical Management
Only 10-30% resectable @ time of
diagnosis
Three Presentations:
GB CA discovered during or after lap/open
chole for assumed benign dz
GB CA suspected after diagnostic evaluation
GB CA advanced stage at presentation
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Surgical Options
Simple cholecystectomy
Radical cholecystectomy
Radical chole w/ anatomic liver resection Radical chole w/ Whipple
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Wh t t d d i l ti l
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What to do during elective lap
chole if GB Ca is suspected
intraoperatively ? ~ 0.5 % of asx cases found to have GB
CA in lap chole
Convert to OPEN
Resect PORTS
No place for laparoscopic resection
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Management of T1 lesions
5Yr survival rates have improved forT1a
dz following simple cholecystectomy75-
100%
T1b(muscularis) is controversial
Simple v radical chole
Wakai (2001) 10 yr survival for T1b tumors
after simple chole was 87%
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Management of T2 lesions
Incidentally detected GB Ca in specimen
Re-exploration w/ radical chole for
T2 lesions or greater
Fong @ MSKCC (1998) improved disease
free survival from ~ 20 60%
De Aretxabala Chile (1997) showedimprovement from 20% 70% 5Yr survival
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Management of locally advanced
T3/T4 lesions
High morbidity & mortality rates (~50% &15%)
Reluctance to operate because of poor
prognosis
Nakamura (1999) found extensive surgeryfor stage IV pts showed significantimprovement in 5Yr survival whencompared to palliativeoperation/unresectable dz
Management of locall
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Management of locally
unresectable dz (major vascular
encasement) NO DEBULKING Chemoradiotherapy
No identified impact on survival & remainsinvestigational
Systemic chemotherapy no optimal regimen
defined (5-FU based)
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Contraindications to resection
Mets to liver, peritoneum, or encasement
of major vessels
Direct involvement of adjacent organs
is NOT absolute contraindication