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Singh BP, Khan WF, Rathore YS, Pol MM. Incidental Carcinoma Gallbladder: Incidence, Risk Factors, and Factors Affecting Survival-5-Year Experience from a Tertiary Care Institute. J Gastrointest Cancer 2019; 51:980-987. [PMID: 31808057 DOI: 10.1007/s12029-019-00347-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Carcinoma gallbladder is a very lethal disease. It can get detected incidentally after laparoscopic cholecystectomy. The overall outcome of incidentally detected carcinoma gallbladder is a matter of debate in literature. AIM To estimate the overall incidence of the incidental gallbladder carcinoma, the various risk factors associated with it and factors affecting overall survival in patients who underwent laparoscopic cholecystectomy with eventual histology turning out to be carcinoma gallbladder. METHODS Data of all the patients undergoing laparoscopic cholecystectomies in one surgical unit under the Department of Surgery at All India Institute of Medical Sciences, New Delhi, India, between January 2014 and December 2018 was retrospectively analyzed. All patients with incidental carcinoma gallbladder were followed up and completion radical cholecystectomy was performed. The demographic profile, preoperative imaging, intra-operative finding, histopathology of primary surgery, and median interval between two surgeries were analyzed to look for various risk factors associated with incidental carcinoma gallbladder and factors affecting overall survival. RESULTS Incidence of the incidental carcinoma gallbladder was 0.51% with a female/male ratio of 4:1 and mean age of 47.2 years. Preoperative imaging of most of them was suggestive of chronic cholecystitis; however, one patient had multiple gallbladder polyps. Six patients had uneventful laparoscopic cholecystectomy, while four had bile spillages intraoperatively. All the patients had adenocarcinoma on histopathology. Pathological staging of four patients was pT1b and six patients had pT2 tumor. The median interval between cholecystectomy and completion radical cholecystectomy in this series was 8 weeks. At the end of 19-month median follow-up, overall survival was 55.5%. CONCLUSION Incidence of incidental carcinoma gallbladder is 0.51%, most commonly affecting middle-aged females. Risk factors associated with incidental carcinoma gallbladder were found to be multiple gallbladder calculi, single large stone, and gallbladder polyps. Survival is better in males, young patients with uneventful primary surgery and better-differentiated pathology.
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Affiliation(s)
- Bhanu Pratap Singh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room no. 5025, 5th Floor, Ansari Nagar, New Delhi, 110029, India
| | - Washim Firoz Khan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room no. 5025, 5th Floor, Ansari Nagar, New Delhi, 110029, India
| | - Yashwant Singh Rathore
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room no. 5025, 5th Floor, Ansari Nagar, New Delhi, 110029, India.
| | - Manjunath Maruti Pol
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room no. 5025, 5th Floor, Ansari Nagar, New Delhi, 110029, India
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Rudasill SE, DiPardo B, Sanaiha Y, Mardock AL, Cale M, Antonios JW, Khoury H, Benharash P. International Normalized Ratio (INR) Is Comparable to MELD in Predicting Mortality after Cholecystectomy. Am Surg 2019; 85:1184-1188. [PMID: 31657321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Guidelines suggest targeting a preoperative international normalized ratio (INR) < 1.5. We examined and compared the predictive value of INR relative to the Model for End-Stage Liver Disease (MELD). We reviewed the American College of Surgeons NSQIP from 2005 to 2016 for adult patients undergoing open or laparoscopic cholecystectomy. Patients with a preoperative INR were stratified into groups: ≤1, >1 to ≤1.5, >1.5 to ≤2, and >2. Thirty day postoperative mortality was the primary outcome. Multivariable logistic regressions controlled for baseline differences. Of 58,177 cholecystectomy patients, 15.2 per cent had INR ≤ 1, 80.4 per cent had INR > 1 to ≤1.5, 3.7 per cent had INR > 1.5 to ≤2, and 0.7 per cent had INR > 2. Patients with INR > 2 were older and more likely to have diabetes and hypertension (P < 0.001). Multivariable regression demonstrated a stepwise increase in mortality for INR > 1 to ≤1.5 (odds ratio (OR) = 1.50 [1.10-2.05]), INR > 1.5 to ≤2 (OR = 2.96 [1.97-4.45]), and INR > 2 (OR = 3.21 [1.64-6.31]) relative to INR ≤ 1. C-statistic for INR (0.910) and MELD (0.906) models indicated a similar value in predicting mortality. INR groups also faced an incremental, increased risk of bleeding. Although unable to track preoperative correction of INR, this analysis identifies that INR remains an excellent predictor of postoperative mortality and bleeding after both open and laparoscopic cholecystectomies and is comparable to MELD.
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Cho JK, Lee W, Jang JY, Kim HG, Kim JM, Kwag SJ, Park JH, Kim JY, Park T, Jeong SH, Ju YT, Jung EJ, Lee YJ, Hong SC, Jeong CY. Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: a retrospective study. World J Surg Oncol 2019; 17:8. [PMID: 30616645 PMCID: PMC6323785 DOI: 10.1186/s12957-018-1556-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While extended cholecystectomy is recommended for T2 gallbladder cancer (GBC), the role of hepatic resection for T2 GBC is unclear. This study aimed to identify the necessity of hepatic resection in patients with T2 GBC. METHODS Data of 81 patients with histopathologically proven T2 GBC who underwent surgical resection between January 1999 and December 2017 were enrolled from a retrospective database. Of these, 36 patients had peritoneal-side (T2a) tumors and 45 had hepatic-side (T2b) tumors. To identify the optimal surgical management method, T2 GBC patients were classified into the hepatic resection group (n = 44, T2a/T2b = 20/24) and non-hepatic resection group (n = 37, T2a/T2b = 16/21). The recurrence pattern and role of hepatic resection for T2 GBC were then investigated. RESULTS Mean age of the patients was 69 (range 36-88) years, and the male-to-female ratio was 42:39 (male, 51.9%; female, 48.1%). Hepatic-side GBC had a higher rate of recurrence than peritoneal-side GBC (44.4% vs. 8.3%, p = 0.006). The most common type of recurrence in T2a GBC was para-aortic lymph node recurrence (n = 2, 5.6%); the most common types of recurrence in T2b GBC were para-aortic lymph node recurrence (n = 7, 15.6%) and intrahepatic metastasis (n = 6, 13.3%). Hepatic-side GBC patients had worse survival outcomes than peritoneal-side GBC patients (76.0% vs. 96.6%, p = 0.041). Hepatic resection had no significant treatment effect in T2 GBC patients (p = 0.272). Multivariate analysis showed that lymph node metastasis was the only significant prognostic factor (p = 0.002). CONCLUSIONS Hepatic resection is not essential for curative treatment in T2 GBC, and more systemic treatments are needed for GBC patients, particularly for those with T2b GBC.
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Affiliation(s)
- Jin-Kyu Cho
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Woohyung Lee
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Jae Yool Jang
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Han-Gil Kim
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Jae-Myung Kim
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Seung-Jin Kwag
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Ji-Ho Park
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Ju-Yeon Kim
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Taejin Park
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Sang-Ho Jeong
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Young-Tae Ju
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Eun-Jung Jung
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Young-Joon Lee
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Soon-Chan Hong
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Chi-Young Jeong
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
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Imran JB, Renteria O, Ruiz M, Pham TH, Mokdad AA, Huerta S. Assessing the Veterans Affairs Surgical Quality Improvement Program Risk Calculator in Cholecystectomy. Am Surg 2018; 84:1039-1042. [PMID: 29981645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk calculator has been validated for several operations but has not been assessed specifically for cholecystectomy. Our aim was to externally validate the VASQIP calculator's accuracy in predicting 30-day morbidity and mortality (M&M) for patients undergoing cholecystectomy. A retrospective review of patients undergoing cholecystectomy at the North Texas Veterans Affairs hospital was performed. The VASQIP risk calculator was used to determine predicted 30-day M&M, which was compared with actual M&M. The predictive accuracy of the Veterans Affairs risk calculator was assessed using the C-statistic and a graphical assessment of a locally weighted least squares regression smoother. Overall, 848 patients were included in the study. Actual M&M were 6.3 and 0.94 per cent, respectively, whereas predicted M&M were 6.0 and 0.54 per cent. The C-statistic was 0.75 for morbidity and 0.78 for mortality. In our analysis, the VASQIP risk calculator reasonably predicted 30-day M&M.
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Schimizzi GV, Jin LX, Davidson JT, Krasnick BA, Ethun CG, Pawlik TM, Poultsides G, Tran T, Idrees K, Isom CA, Weber SM, Salem A, Hawkins WG, Strasberg SM, Doyle MB, Chapman WC, Martin RCG, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Maithel SK, Fields RC. Outcomes after vascular resection during curative-intent resection for hilar cholangiocarcinoma: a multi-institution study from the US extrahepatic biliary malignancy consortium. HPB (Oxford) 2018; 20:332-339. [PMID: 29169904 PMCID: PMC5970648 DOI: 10.1016/j.hpb.2017.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical resection is the cornerstone of curative-intent therapy for patients with hilar cholangiocarcinoma (HC). The role of vascular resection (VR) in the treatment of HC in western centres is not well defined. METHODS Utilizing data from the U.S. Extrahepatic Biliary Malignancy Consortium, patients were grouped into those who underwent resection for HC based on VR status: no VR, portal vein resection (PVR), or hepatic artery resection (HAR). Perioperative and long-term survival outcomes were analyzed. RESULTS Between 1998 and 2015, 201 patients underwent resection for HC, of which 31 (15%) underwent VR: 19 patients (9%) underwent PVR alone and 12 patients (6%) underwent HAR either with (n = 2) or without PVR (n = 10). Patients selected for VR tended to be younger with higher stage disease. Rates of postoperative complications and 30-day mortality were similar when stratified by vascular resection status. On multivariate analysis, receipt of PVR or HAR did not significantly affect OS or RFS. CONCLUSION In a modern, multi-institutional cohort of patients undergoing curative-intent resection for HC, VR appears to be a safe procedure in a highly selected subset, although long-term survival outcomes appear equivalent. VR should be considered only in select patients based on tumor and patient characteristics.
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Affiliation(s)
- Gregory V Schimizzi
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Linda X Jin
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Jesse T Davidson
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Bradley A Krasnick
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, United States
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, United States
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Chelsea A Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - William G Hawkins
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Steven M Strasberg
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Maria B Doyle
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - William C Chapman
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, United States
| | - Charles Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, United States
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, United States
| | - Harveshp D Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, United States
| | - Carl Schmidt
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Eliza Beal
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Ioannis Hatzaras
- Department of Surgery, New York University, New York, NY, United States
| | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY, United States
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Ryan C Fields
- Department of Surgery and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, United States.
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Liang TJ, Liu SI, Chen YC, Chang PM, Huang WC, Chang HT, Chen IS. Analysis of gallstone disease after gastric cancer surgery. Gastric Cancer 2017; 20:895-903. [PMID: 28154944 DOI: 10.1007/s10120-017-0698-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence rate of newly developed gallstone disease after gastrectomy for gastric cancer is thought to be higher than that in the general population. However, the presentation and management of these gallstones remain under debate, and the role of prophylactic cholecystectomy remains questionable. METHODS Data on adult patients who were diagnosed with gastric cancer and received gastrectomy between 2000 and 2011 were extracted from the Taiwan National Health Insurance Research Database. A patient was excluded if he or she had gallstone disease or received cholecystectomy before the index date. The incidence of newly developed gallstone disease and its subsequent management were recorded. Data were analyzed to evaluate the factors associated with gallstone development and treatment options. RESULTS A total of 17,325 gastric cancer patients who underwent gastrectomy were eligible for analysis. During the follow-up period (mean 4.1 years; median, 2.9 years), 1280 (7.4%) patients developed gallstone disease and 560 (3.2%) patients subsequently underwent cholecystectomy. The in-hospital mortality for cholecystectomy was 1.8% (10/560). Development of gallstone disease was associated with older age, total gastrectomy, duodenal exclusion, diabetes, cirrhosis, and more comorbidities. Factors associated with the use of cholecystectomy to treat gallstone disease included younger age, fewer comorbidities, medical center admission, and presentation as cholecystitis. CONCLUSIONS Although few patients required further gallbladder removal after gastrectomy for gastric malignancy, the increased mortality rate for subsequent cholecystectomy was worth noting. The decision to undergo prophylactic cholecystectomy might be individualized based upon patient characteristics and the surgeon's discretion.
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Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chia Chen
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
| | - Po-Min Chang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
| | - Wei-Chun Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hong-Tai Chang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Shu Chen
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.
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Yeo CSW, Tay VWY, Low JK, Woon WWL, Punamiya SJ, Shelat VG. Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy. J Hepatobiliary Pancreat Sci 2016; 23:65-73. [PMID: 26580708 DOI: 10.1002/jhbp.304] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) is an established treatment for high surgical risk patients with acute cholecystitis. This paper studies factors predictive of mortality and eventual cholecystectomy. METHODS A retrospective review of all patients who underwent PC from March 2005 to March 2015 was performed. Patient demographics, clinical features, comorbidity profile, grade of cholecystitis, interval between cholecystitis diagnosis and PC, and method of PC were studied. Length of stay, complications, readmission rate, mortality and eventual cholecystectomy were studied. For patients with eventual cholecystectomy, operative data and perioperative outcomes were studied. RESULTS One hundred and three patients with median age of 80 years (range 43-105) underwent PC. Median interval to PC was 2 days (range 0-15). 9.7% of patients had complications. Median length of stay was 19 days (range 3-206). 41% underwent eventual cholecystectomy. 30-day mortality rate was 10.7%. Higher APACHE II scores (P = 0.004), higher Charlson comorbidity index (CCI) (P = 0.009), and longer interval from diagnosis to PC (P = 0.037) were associated with in-hospital mortality. Younger age (P = 0.015), lower APACHE II scores (P = 0.043) and lower CCI (P = 0.002) were associated with eventual cholecystectomy. CONCLUSION Percutaneous cholecystostomy is safe and effective in treatment of acute cholecystitis. Prompt PC improves survival in high risk surgical patients. Comorbidity severity is associated with mortality. Patients with lesser comorbidity are likely to receive eventual cholecystectomy.
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Affiliation(s)
- Charleen Shan Wen Yeo
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Vivyan Wei Yen Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Winston Wei Liang Woon
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Sundeep J Punamiya
- Department of Interventional Radiology, Tan Tock Seng Hospital, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Jung W, Jang JY, Kang MJ, Chang YR, Shin YC, Chang J, Kim SW. Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer. Gut Liver 2016; 10:140-6. [PMID: 26347513 PMCID: PMC4694746 DOI: 10.5009/gnl15080] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Extended cholecystectomy is generally recommended for patients with T2 gallbladder cancer. However, few studies have assessed the extent of resection relative to T2 gallbladder tumor location. This study analyzed the effects of surgical methods and tumor location on survival outcomes and tumor recurrence in patients with T2 gallbladder cancer. METHODS Clinicopathological characteristics, extent of resection, survival rates, and recurrence patterns were retrospectively analyzed in 88 patients with pathologically confirmed T2 gallbladder cancer. RESULTS The 5-year disease-free survival rate was 65.0%. Multivariate analysis showed that lymph node metastasis was the only independent risk factor for poor 5-year disease-free survival rate. Survival outcomes were not associated with tumor location. Survival tended to be better in patients who underwent extended cholecystectomy than in those who underwent simple cholecystectomy. Recurrence rate was not affected by surgical method or tumor location. Systemic recurrence was more frequent than local recurrence without distant recurrence. Gallbladder bed recurrence and liver recurrence were relatively rare, occurring only in patients with liver side tumors. CONCLUSIONS Extended cholecystectomy is the most appropriate treatment for T2 gallbladder cancer. However, simple cholecystectomy with regional lymph node dissection may be appropriate for patients with serosal side tumors.
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Affiliation(s)
- Woohyun Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Mee Joo Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Ye Rim Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Chan Shin
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Jihoon Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
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Abstract
The outcome of gallbladder carcinoma is poor, and the overall 5-year survival rate is less than 5%. In early-stage disease, a 5-year survival rate up to 75% can be achieved if stage-adjusted therapy is performed. There is wide geographic variability in the frequency of gallbladder carcinoma, which can only be explained by an interaction between genetic factors and their alteration. Gallstones and chronic cholecystitis are important risk factors in the formation of gallbladder malignancies. Factors such as chronic bacterial infection, primary sclerosing cholangitis, an anomalous junction of the pancreaticobiliary duct, and several types of gallbladder polyps are associated with a higher risk of gallbladder cancer. There is also an interesting correlation between risk factors and the histological type of cancer. However, despite theoretical risk factors, only a third of gallbladder carcinomas are recognized preoperatively. In most patients, the tumor is diagnosed by the pathologist after a routine cholecystectomy for a benign disease and is termed ‘‘incidental or occult gallbladder carcinoma’’ (IGBC). A cholecystectomy is performed frequently due to the minimal invasiveness of the laparoscopic technique. Therefore, the postoperative diagnosis of potentially curable early-stage disease is more frequent. A second radical re-resection to complete a radical cholecystectomy is required for several IGBCs. However, the literature and guidelines used in different countries differ regarding the radicality or T-stage criteria for performing a radical cholecystectomy. The NCCN guidelines and data from the German registry (GR), which records the largest number of incidental gallbladder carcinomas in Europe, indicate that carcinomas infiltrating the muscularis propria or beyond require radical surgery. According to GR data and current literature, a wedge resection with a combined dissection of the lymph nodes of the hepatoduodenal ligament is adequate for T1b and T2 carcinomas. The reason for a radical cholecystectomy after simple CE in a formally R0 situation is either occult invasion or hepatic spread with unknown lymphogenic dissemination. Unfortunately, there are diverse interpretations and practices regarding stage-adjusted therapy for gallbladder carcinoma. The current data suggest that more radical therapy is warranted.
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Ercan M, Bostanci EB, Cakir T, Karaman K, Ozer I, Ulas M, Dalgic T, Ozogul Y, Aksoy E, Akoglu M. The rationality of resectional surgery and palliative interventions in the management of patients with gallbladder cancer. Am Surg 2015; 81:591-599. [PMID: 26031272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to evaluate in a retrospective manner, the survival period and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions. Between 2003 and 2012, 67 patients diagnosed with gallbladder carcinoma were retrospectively analyzed. Patient demographics, the survival period, and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions were retrospectively analyzed. Sixty-seven patients were diagnosed with gallbladder carcinoma. Thirty-eight patients (56.7%) were female and 29 patients (43.3%) were male. The median survival period was significantly longer in stage II and III diseases than in stage IV disease (P < 0.001). The R0, R1, and R2 resection rates in patients who underwent surgery with curative intent were 67.7, 19.4, and 12.9 per cent, respectively. The R0 resection rate according to the tumor stages was 100 per cent for stage I, 87.5 per cent for stage II, 66.7 per cent for stage III, and 42.8 per cent for stage IV disease. The median follow-up period was six months (eight days to 36 months). During this follow-up period, 53 patients (79.1%) died. In conclusion, R0 resection rate decreases when tumor stage increases. The highest survival rates after R0 resection are achieved in patients with stage I, II, and III diseases. Radical surgery has no benefit over palliative surgery for stage IV disease in terms of survival.
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Affiliation(s)
- Metin Ercan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
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11
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He XD, Li JJ, Liu W, Qu Q, Hong T, Xu XQ, Li BL, Wang Y, Zhao HT. Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer. World J Gastroenterol 2015; 21:4620-4626. [PMID: 25914471 PMCID: PMC4402309 DOI: 10.3748/wjg.v21.i15.4620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/11/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis (TNM) staging system.
METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system (AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy (or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm non-neoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient’s circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. Kaplan-Meier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was considered statistically significant.
RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage I, 25 cases of stage II, 21 cases of stage IIIA, 21 cases of stage IIIB, 24 cases of stage IVA, 43 cases of stage IVB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and I disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy (P = 0.826). The prognosis of stage II patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage III patients, radical cholecystectomy was significantly superior to other surgical options (P < 0.05). For stage IVA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage IVB, patients who underwent palliative resection significantly outlived those with non-surgical treatment (P < 0.01)
CONCLUSION: For stages 0 and I patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages II and III patients.
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Yun SP, Shin N, Seo HI. Clinical outcomes of small cell neuroendocrine carcinoma and adenocarcinoma of the gallbladder. World J Gastroenterol 2015; 21:269-275. [PMID: 25574101 PMCID: PMC4284345 DOI: 10.3748/wjg.v21.i1.269] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/02/2014] [Accepted: 09/19/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To compare the demographics and survival rates between gallbladder adenocarcinoma (GB-adenocarcinoma) and small cell neuroendocrine carcinoma of the gallbladder (GB-NEC-SCC).
METHODS: From March 2007 to September 2012, patients who underwent resection of tumor stage T2/T3 GB cancer were enrolled for this study. Forty-two patients were included in this study, including 38 diagnosed with GB-adenocarcinoma and four diagnosed with GB-NEC-SCC. In the GB-adenocarcinoma group, a radical operation was performed in 28 patients, and ten patients underwent simple cholecystectomy. In the GB-NEC-SCC group, a radical operation was performed in three patients, and one patient underwent simple cholecystectomy. Comparative analysis of the two groups was performed, including clinicopathologic features and survival rates.
RESULTS: The median age of the patients was 68 y (range: 35-83 years) and females comprised 26/42 of the patients. GB-adenocarcinoma patients were significantly older than GB-NEC-SCC patients (67.89 ± 11.15 vs 55.75 ± 10.31 years; P = 0.029). The median tumor size in GB-adenocarcinoma patients was 2.56 ± 1.75 cm and 3.98 ± 3.74 cm in GB-NEC-SCC patients; however, there was no significant difference between the two groups. For tumors > 2 cm, T stage (T2 vs T3), lymphovascular invasion, perineural invasion, lymph node metastasis and lymph node ratio showed no significant differences between the two groups. The overall survival rate of the 42 patients at five years was 77.0%. In the GB-adenocarcinoma group, the overall five-year survival rate was 74.8%, and survival in the GB-NEC-SCC group was 100%, which was not significantly different between the two groups.
CONCLUSION: The strategy for treating patients with GB-NEC-SCC should be similar to that used for treating GB-adenocarcinoma, including radical cholecystectomy and liver resection.
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Eachempati SR, Cocanour CS, Dultz LA, Phatak UR, Albarado R, Rob Todd S. Acute cholecystitis in the sick patient. Curr Probl Surg 2014; 51:441-66. [PMID: 25497405 DOI: 10.1067/j.cpsurg.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/30/2014] [Indexed: 12/24/2022]
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Kaibori M, Kubo S, Nagano H, Hayashi M, Nakai T, Ishizaki M, Matsui K, Uenishi T, Takemuraz S, Wada H, Marubashi S, Komeda K, Hirokawa F, Nakata Y, Uchiyama K, Kwon M. Higher complication rate in hepatocellular carcinoma patients undergoing prophylactic cholecystectomy with curative hepatic resection. Hepatogastroenterology 2014; 61:2028-2034. [PMID: 25713906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS We performed a retrospective analysis to evaluate the short and long-term impact of simultaneous prophylactic cholecystectomy with hepatectomy in these patients. METHODS We identified 642 patients who underwent curative hepatocellular carcinoma resection between 2001 and 2005 at five university hospitals. One hundred and twenty-five hepatocellular carcinoma patients who received left lateral sectionectomy or partial resection in the left lateral and Spiegel lobes were identified and followed. They were divided into two groups, 74 with and 51 without simultaneous cholecystectomy. None of these patients had gallbladder stones or polyps at preoperative diagnosis. RESULTS Although not statistically significant, the operating time was longer and blood loss was greater in the cholecystectomy group. Patients in the cholecystectomy group had a significantly higher postoperative morbidity rate. Surgical complications according to the Clavien classification differed significantly between the two groups. Variables significantly associated with complications in the univariate and multivariate analyses were simultaneous cholecystectomy and operative blood loss ≥ 1000 ml. CONCLUSION Simultaneous cholecystectomy of the asymptomatic gallbladder with curative resection of hepatocellular carcinoma in the left lateral section or Spiegel lobe resulted in higher postoperative complications. Consequently, the gallbladder should be preserved except in cases of gallbladder stones or polyps.
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Wiggers JK, Groot Koerkamp B, Ovadia Z, Busch ORC, Gouma DJ, van Gulik TM. Patterns of recurrence after resection of gallbladder cancer without routine extrahepatic bile duct resection. HPB (Oxford) 2014; 16:635-40. [PMID: 24246159 PMCID: PMC4105901 DOI: 10.1111/hpb.12188] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/17/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Routine extrahepatic bile duct (EBD) resection in non-jaundiced patients with gallbladder cancer (GBC) is controversial. The aim of this study was to retrospectively analyse patterns of recurrence in patients who underwent resection of GBC without routine EBD resection. METHODS This analysis referred to 58 patients who had undergone explorative laparotomy for GBC during 2000-2012 at a single, tertiary referral centre. Overall survival, time to recurrence, and patterns of recurrence were assessed in patients who underwent conventional negative-margin (R0) resection without routine EBD resection. RESULTS Of 58 patients submitted to explorative laparotomy for GBC, 26 (45%) patients underwent R0 resection without EBD resection (tumour stage T1b in five patients, T2 in 17, T3 in three, and T4 in one). The 3-year survival rate among these patients was 78% at a median follow-up of 33 months (range: 13-127 months). Seven patients developed recurrent disease at a median of 9 months (range: 2-25 months) after resection. No patients developed isolated recurrent disease at the EBD. CONCLUSIONS Of 26 patients resected for GBC, none developed isolated recurrent disease at the EBD after conventional resection of GBC without EBD resection. This finding suggests that routine EBD resection is of no additional value.
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Affiliation(s)
- Jimme K Wiggers
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
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Wu TC, Fang CH, Liu WY, Cai W, Fan YF, Yang J, Zeng N, Zhong SZ, Bao SS. 3D Reconstruction Aids Surgery For Complicated Hepatolithiasis. Hepatogastroenterology 2014; 61:613-622. [PMID: 26176045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Three-dimensional (3D) imaging may improve surgical interventions for complicated hepatolithiasis. METHODOLOGY Between July 2008 and December 2012 a total of 131 patients with complicated hepatolithiasis underwent surgical therapy in the Department of Hepatobiliary Surgery Zhujiang Hospital, Southern Medical University. 77 patients received preoperative planning using a computed tomography (CT)-based 3D reconstruction technique, and 54 received treatment based on preoperative planning with traditional imaging (CT, ultrasonography, magnetic resonance imaging/magnetic resonance cholangiography). Perioperative and long-term outcomes were analyzed. RESULTS 3D reconstruction facilitated significantly more accurate diagnosis of pathological morphology than conventional imaging methods, as confirmed during surgery. Patients that received 3D reconstruction preoperative planning had significantly better clinical outcomes. The immediate stone clearance rates were 92.2% and 61.1%, respectively. Additional postoperative choledochoscopic lithotripsy raised the clearance rates to 94.8% and 81.5%, respectively. The hospital mortality rates were 0% and 1.9%, respectively, and the complication rates were 33.8% and 44.4%, respectively. With a median follow-up of 28 months (5-38 months), the long-term overall asymptomatic survival rates were 80.5% and 46.3%, respectively. 3D reconstruction preoperative planning was a significant prognostic protective factor of long-term asymptomatic survival for the patients with complicated hepatolithiasis (Cox regression analysis, RR = 0.348, 95% confidence interval 0.185-0.657, p = 0.001). CONCLUSION Surgical therapy conducted following preoperative planning using 3D reconstruction achieved better clinical outcomes than conventional imaging techniques. Whilst conventional imaging techniques accurately identify intrahepatic stones, they are less capable of identifying bile duct stricture.
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Lee NK, Kim CY, Park YJ, Yang DS, Yoon WS, Suh SO. Intraoperative Radiation Therapy for Gallbladder Cancer: Experience at a Single Institution. Hepatogastroenterology 2014; 61:580-586. [PMID: 26176039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS To investigate the survival outcome of intraoperative radiation therapy for patients with gallbladder cancer on the basis of experience at a single institution. METHODOLOGY The medical records of 8 patients with gallbladder cancer who were treated with intraoperative radiation therapy during surgical resection or palliative surgery were retrospectively analyzed. The primary endpoint was overall survival. The median follow-up time was 20.8 months. RESULTS The median survival time was 15.0 months. Overall survival for all patients was 75.0% at 1 year, 37.5% at 3 years, and 25.0% at 5 years. Three patients underwent complete resection, and 5 patients had residual tumor after resection or palliative surgery. The 3-year OS rate for 3 patients with no residual tumor after curative resection was 66.7%, with a mean survival time of 122.6 months, whereas the 3-year OS rate for 5 patients with macroscopic residual diseasewas 0% with a mean survival time of 13.5 months (P = 0.014). CONCLUSIONS The results of the present study suggest that intraoperative radiation therapy with or without external beam radiation therapy was safe and beneficial for patients who underwent curative resection with negative margins and allows the possibility of long-term survival.
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Fridén T, Andrén-Sandberg Å. [Injuries in gallbladder surgery--again and again. Event analyses indicate that it is time to learn from the mistakes]. Lakartidningen 2014; 111:547-550. [PMID: 24734377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Liu GJ, Li XH, Chen YX, Sun HD, Zhao GM, Hu SY. Radical lymph node dissection and assessment: Impact on gallbladder cancer prognosis. World J Gastroenterol 2013; 19:5150-5158. [PMID: 23964151 PMCID: PMC3746389 DOI: 10.3748/wjg.v19.i31.5150] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/11/2013] [Accepted: 07/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the lymph node metastasis patterns of gallbladder cancer (GBC) and evaluate the optimal categorization of nodal status as a critical prognostic factor.
METHODS: From May 1995 to December 2010, a total of 78 consecutive patients with GBC underwent a radical resection at Liaocheng People’s Hospital. A radical resection was defined as removing both the primary tumor and the regional lymph nodes of the gallbladder. Demographic, operative and pathologic data were recorded. The lymph nodes retrieved were examined histologically for metastases routinely from each node. The positive lymph node count (PLNC) as well as the total lymph node count (TLNC) was recorded for each patient. Then the metastatic to examined lymph nodes ratio (LNR) was calculated. Disease-specific survival (DSS) and predictors of outcome were analyzed.
RESULTS: With a median follow-up time of 26.50 mo (range, 2-132 mo), median DSS was 29.00 ± 3.92 mo (5-year survival rate, 20.51%). Nodal disease was found in 37 patients (47.44%). DSS of node-negative patients was significantly better than that of node-positive patients (median DSS, 40 mo vs 17 mo, χ2 = 14.814, P < 0.001), while there was no significant difference between N1 patients and N2 patients (median DSS, 18 mo vs 13 mo, χ2 = 0.741, P = 0.389). Optimal TLNC was determined to be four. When node-negative patients were divided according to TLNC, there was no difference in DSS between TLNC < 4 subgroup and TLNC ≥ 4 subgroup (median DSS, 37 mo vs 54 mo, χ2 = 0.715, P = 0.398). For node-positive patients, DSS of TLNC < 4 subgroup was worse than that of TLNC ≥ 4 subgroup (median DSS, 13 mo vs 21 mo, χ2 = 11.035, P < 0.001). Moreover, for node-positive patients, a new cut-off value of six nodes was identified for the number of TLNC that clearly stratified them into 2 separate survival groups (< 6 or ≥ 6, respectively; median DSS, 15 mo vs 33 mo, χ2 = 11.820, P < 0.001). DSS progressively worsened with increasing PLNC and LNR, but no definite cut-off value could be identified. Multivariate analysis revealed histological grade, tumor node metastasis staging, TNLC and LNR to be independent predictors of DSS. Neither location of positive lymph nodes nor PNLC were identified as an independent variable by multivariate analysis.
CONCLUSION: Both TLNC and LNR are strong predictors of outcome after curative resection for GBC. The retrieval and examination of at least 6 nodes can influence staging quality and DSS, especially in node-positive patients.
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Abstract
OBJECTIVES The role of surgery in stage IV gallbladder (GB) cancer is not well established. This study analyses prognostic factors in patients with stage IV GB cancer following surgical resection with the aim of identifying a subgroup of patients who might benefit from surgical resection. METHODS Clinicopathological details were analysed for 94 patients who were surgically treated for stage IV GB cancer at Seoul National University Hospital. RESULTS Median survival was 8 months in patients with either stage IVa or IVb disease. Sixteen patients (17.0%) underwent resection with curative intent, which increased overall survival over that in patients undergoing palliative surgery (P < 0.001). No survival benefit was seen following surgery with curative intent in patients with stage IVa disease (P = 0.764). Surgery with curative intent resulted in a survival benefit in patients with stage IVb disease, patients with an isolated liver metastasis near the GB bed (median survival: 31 months vs. 9 months; P < 0.001) and patients with limited numbers of peritoneal implantations (median survival: 20 months vs. 6 months; P = 0.002). Preoperative serum carcinoembryonic antigen (CEA) (P = 0.018), surgery with curative intent (P = 0.045) and adjuvant chemotherapy (P = 0.002) were independent prognostic factors in patients with stage IV GB cancer. CONCLUSIONS Surgery in combination with systemic chemotherapy may be beneficial in carefully selected patients with stage IVb GB cancer.
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Affiliation(s)
- Mee Joo Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Törnqvist B, Strömberg C, Persson G, Nilsson M. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 2012; 345:e6457. [PMID: 23060654 PMCID: PMC3469410 DOI: 10.1136/bmj.e6457] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. DESIGN Population based cohort study. SETTING Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. POPULATION All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. MAIN OUTCOME MEASURES Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. RESULTS During the study, 51,041 cholecystectomies were registered in GallRiks and 747 (1.5%) iatrogenic bile duct injuries identified. Patients with bile duct injuries had an impaired survival compared with those without injury (mortality at one year 3.9% v 1.1%). Kaplan-Meier analysis showed that early detection of a bile duct injury, during the primary operation, improved survival. The intention to use intraoperative cholangiography reduced the risk of death after cholecystectomy by 62% (hazard ratio 0.38 (95% confidence interval 0.31 to 0.46)). CONCLUSIONS The high incidence of bile duct injury recorded is probably from GallRiks' ability to detect the entire range of injury severities, from minor ductal lesions to complete transections of major ducts. Patients with bile duct injury during cholecystectomy had impaired survival, and early detection of the injury improved survival. The intention to perform an intraoperative cholangiography reduced the risk of death after cholecystectomy.
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Affiliation(s)
- Björn Törnqvist
- Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Supe A. Asymptomatic gall stones--revisited. Trop Gastroenterol 2011; 32:196-203. [PMID: 22332335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
India has a large burden of individuals harboring asymptomatic gallstones. Based on Markov model decision and cost analysis, selective and concomitant cholecystectomy is recommended for special indications like hemolytic disorders and stones in endemic areas. Expectant management should be adopted in all others. The evolution of laparoscopy should not alter the indications of cholecystectomy. Since more than 90% patients with asymptomatic gallstones remain clinically "silent", routine laparoscopic cholecystectomy is not indicated for the vast majority of subjects with asymptomatic cholelithiasis. Although laparoscopic cholecystectomy has become much safer, there remains associated morbidity and mortality. The risks of the operation outweigh the complications if stones are left in-situ. Patients should be counseled about the natural history and available management options, their advantages and disadvantages, and should be part of the decision making process. Prophylactic routine cholecystectomy for asymptomatic stones is not recommended. However, laparoscopic cholecystectomy should be performed selectively or concomitantly in a specific subgroup of patients.
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Affiliation(s)
- Avinash Supe
- Department of GI Surgery, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400012, India.
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Yu P, Chang DC, Osen HB, Talamini MA. NSQIP reveals significant incidence of death following discharge. J Surg Res 2011; 170:e217-24. [PMID: 21816434 DOI: 10.1016/j.jss.2011.05.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/09/2011] [Accepted: 05/24/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The rates of post-discharge deaths after surgical procedures are unknown and may represent areas of quality improvement. The NSQIP database captures 30-d outcomes not included within normal administrative databases, and can thus differentiate between in-hospital and post-discharge deaths. METHODS Retrospective analysis of NSQIP from 2005 through 2007. Inclusion criteria were procedures whose median length of stay was greater than 1 d (to exclude outpatient procedures), and whose overall death rate was greater than 2% (to include only procedures where mortality was a significant issue). Procedures where less than 25 deaths occurred were excluded (for sample size concerns). RESULTS There were 363,897 patients with 2236 different CPT codes captured in NSQIP. There were 6395 deaths; among them, 1486 (23.2%) occurred after discharge. Thirty-eight CPT codes met the analysis threshold. In two of the CPT codes, there were no post-discharge deaths (repair of ruptured abdominal aortic aneurysm [AAA], repair of ruptured AAA involving iliacs). In the other 36 CPT codes, the proportion of deaths occurring after discharge ranged from 6.3% (repair of thoracoabdominal aneurysm) to 50.0% (femoral-distal bypass with vein). The highest percentage of post-discharge mortality occurs on d 1 after discharge. Fifty percent of post-discharge mortality occurs by d 7; 95% occurs by d 21. CONCLUSION Approximately one-fourth of postoperative deaths occur after hospital discharge. There is significant variation across surgical procedures in the likelihood of postoperative deaths occurring after discharge. These data indicate a need for closer and more frequent monitoring of post-surgical patients. These data also call into question conclusions drawn from hospital-based outcomes analyses for at least some key diseases/procedures. This analysis demonstrates the power of the risk-adjusted 30-d follow-up NSQIP data, but perhaps more importantly, the responsibility of surgeons to monitor and optimize the discharge process.
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Affiliation(s)
- Peter Yu
- Department of Surgery, University of California San Diego, San Diego, California 92103-8402, USA.
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Scollay JM, Mullen R, McPhillips G, Thompson AM. Mortality associated with the treatment of gallstone disease: a 10-year contemporary national experience. World J Surg 2011; 35:643-7. [PMID: 21181471 DOI: 10.1007/s00268-010-0908-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gallstones remain a common clinical problem requiring skilled operative and nonoperative management. The aim of the present population-based study was to investigate causes of gallstone-related mortality in Scotland. METHODS Surgical deaths were peer reviewed between 1997 and 2006 through the Scottish Audit of Surgical Mortality (SASM); data were analyzed for patients in whom the principal diagnosis on admission was gallstone disease. RESULTS Gallstone disease was responsible for 790/43,271 (1.83%) of the surgical deaths recorded, with an overall mortality for cholecystectomy of 0.307% (176/57,352), endoscopic retrograde cholangiopancreatography (ERCP) of 0.313% (117/37,345), and cholecystostomy of 2.1% (12/578) across the decade. However, the majority of patients who died were elderly (47.6% ≥ 80 years or older) and were managed conservatively. Deaths following cholecystectomy usually followed emergency admission (76%) and were more likely to have been associated with postoperative medical complications (n = 189) than surgical complications (n = 36). DISCUSSION Although cholecystectomy is a relatively safe procedure, patients who die as a result of gallstone disease tend to be elderly, to have been admitted as emergency cases, and to have had co-morbidities. Future combined medical and surgical perioperative management may reduce the mortality rate associated with gallstones.
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Affiliation(s)
- John M Scollay
- Department of Surgery, Ninewells Hospital and Medical School, Dundee D1 9SY, UK.
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Yousefpour Azary S, Kalbasi H, Setayesh A, Mousavi M, Hashemi A, Khodadoostan M, Zali MR, Mohammad Alizadeh AH. Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy. Hepatobiliary Pancreat Dis Int 2011; 10:308-12. [PMID: 21669576 DOI: 10.1016/s1499-3872(11)60051-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures, and thus, whether it will become a routine diagnostic procedure. The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population. METHODS In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008, baseline data and perioperative information of 2060 patients (male to female ratio 542:1518, mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed. The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined. RESULTS Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%, respectively. Both early mortality and morbidity due to cholecystectomy were higher in male than female. The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female, P=0.008). Among those without gallstones, 8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones. The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were: advanced age (OR=1.022, P=0.001), male gender (OR=1.498, P=0.050), history of abdominal surgery (OR=1.543, P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400, P<0.001). CONCLUSIONS IOC is a safe and accurate method for the assessment of bile duct anatomy and stones. Therefore, the routine use of IOC within cholecystectomy seems reasonable and is recommended.
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Affiliation(s)
- Shahram Yousefpour Azary
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
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Fathy O, Wahab MA, Hamdy E, Elshoubary M, Kandiel T, Elraof AA, Elhemaly M, Salah T, Elhanafy E, Atef E, Sultan AM, Elebiedy G, Anwar N, Sultan A. Post-cholecystectomy biliary injuries: one center experience. Hepatogastroenterology 2011; 58:719-724. [PMID: 21830376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIMS Post-cholecystectomy bile duct injuries (BDIs) represent a challenge in diagnosis and management. METHODOLOGY From March 1995 to August 2009, 274 patients with post-cholecystectomy BDIs were managed at our center. All patients were subjected to laboratory tests, sonography, ERCP and MRCP. The management varied according to the type of injury. RESULTS Seventy-one (25.9%) LC and 203 (74.1%) OC were performed; 8(2.9%) were detected intraoperatively; 270 patients were referred from other hospitals. From those discovered intraoperatively, 7 had hepatico-jejunostomy and one died from severe peritonitis; 11 (4%) presented with generalized and 112 (40.9%) with localized peritonitis. The leak site was the cystic duct (57 cases), accessory duct in the liver bed (5 cases), right hepatic duct (4 cases) and lateral tear in the CBD (12 cases). Endoscopic stenting was performed for all of them. The remaining 34 patients had a completely ligated distal duct and therefore had hepatico-jejunostomy Roux loop; 143 patients (52.2%) presented with early (79 cases) and late (64 cases) jaundice; 126 cases had hepatico-jejunostomy. The remaining 17 patients were treated by balloon dilatation. CONCLUSIONS Endoscopic stenting can manage cases with cystic or accessory duct leak while, hepatico-jejunostomy Roux loop represents the golden procedure for management of transected or ligated CBD.
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Affiliation(s)
- Omar Fathy
- Gastroenterology Center, Mansoura University, Egypt.
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Rampa M, Boati P, Battaglia L, Leo E, Vannelli A. [Elective laparoscopic cholecystectomy: the limit of a dream become true]. G Chir 2011; 32:77-82. [PMID: 21352716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Laparoscopic technique in elective cholecystectomy is the last step in an evolutive time to minimize the abdominal access. From 1st January 2004 to 31th December 2006 we analyzed 5515 cholecystectomy procedures: 4877 laparoscopic cholecystectomy, 635 open cholecystectomy. Complications and supplementary diagnosis have been identified in SDO Lombardia's country database. Morbidity occurred in 82 patients (12.9%) with open technique and 109 patients (2.23%) with laparoscopic technique; mortality occurred in 11 patients (1.73%) with open technique and 1 patient (0.02%) with laparoscopic technique. Mean hospital stay are 14.40 days with open technique and 4.75 with laparoscopic technique. Morbidity in open technique is 6 fold more than laparoscopia technique. The difference between the two technique is present in literature and it's the result of non invasive technique compared with the incision of the laparoscopia technique. This is the critical point in the difference of hospital stay between the two technique all to the good of laparoscopy. The high mortality ratio is due to the selective criteria in laparoscopic technique. First remark is the high quality of our hospital care, compared with hospital teaching in the word. In this hospital the laparoscopic cholecystectomy is the gold standard in cholelitiasis treatment. The second remark is the limit of the open technique in severe cholelitiasis with evidence in high ratio of hospital stay, morbidity and mortality.
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Affiliation(s)
- M Rampa
- Foundation IRCSS Istituto Nazionale dei Tumori, Milano, Italy
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Brezean I, Aldoescu S, Catrina E, Fetche N, Marin I, Păcescu E. Gallstone ileus: analysis of eight cases and review of the literature. Chirurgia (Bucur) 2010; 105:355-359. [PMID: 20726301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We hereby analyzed a series of gallstone ileus cases operated on in our department starting from a Bouveret syndrome case. METHOD Retrospective analysis of all gallstone ileus cases who underwent surgery in our department during the last 26 years. We took into consideration diagnostic elements, time from admission to surgery, type of surgery and post-operative outcome. RESULTS During this period 9,143 gallstones were deferred to surgery; 27 biliary-digestive fistulae were discovered during surgery; gallstone ileus complicated fistula in 8 patients. Gallstone ileus was exclusively present in elderly women with associated comorbidities. Diagnosis was suggested by clinical features of acute or incomplete intestinal obstruction; it was sustained by imagistic studies with different degrees of relevance. The average time from admission to surgery was 2.6 days. Surgical approach varied from simple enterolithotomy to additional fistula repair. The outcome was uneventful in most of the cases with only one exception. CONCLUSIONS gallstone ileus is a rare condition, occurring in elders with important comorbidities. The choice for surgical procedure depends on the obstructive syndrome's gravity and associated comorbidities; the type of intervention does not significantly influence post-operative morbidity and mortality rates.
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Affiliation(s)
- I Brezean
- Department of Surgery, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania.
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Dutka IR, Pavlovs'kyĭ MP. [Possibilities of radical surgical treatment of patients with tumoral obstruction of extrahepatic biliary ducts]. Klin Khir 2008:90-92. [PMID: 18677894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Experience of radical surgical treatment of 32 patients, suffering extrahepatic biliary ducts (EBD) tumor, was analyzed. The respectability index of a Clatskin tumor have constituted 12.5%, and of the EBD middle portion--25%. In 8 patients an open operative intervention was performed and in 1--laparoscopic procedure was applied. The respectability index of a distal EBD tumors have constituted 29.6%. Postoperative lethality was 15.6%.
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Bektas H, Schrem H, Winny M, Klempnauer J. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 2007; 94:1119-27. [PMID: 17497652 DOI: 10.1002/bjs.5752] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Different injury patterns of iatrogenic bile duct lesions after cholecystectomy have prompted the proposal of several different clinical classification systems. The aim of this study was to validate these systems comparatively. METHODS Results after surgical intervention for iatrogenic bile duct lesions in 74 consecutive patients at a tertiary referral centre were reviewed retrospectively. A new classification (Hannover classification) for iatrogenic bile duct lesions is proposed and compared with four other systems using the present clinical data. RESULTS Additional vascular lesions were found in 19 per cent. The hospital mortality rate was 3 per cent and the overall hospital complication rate after repair was 26 per cent. Sixteen of 74 patients required early surgical reintervention. The Hannover classification demonstrated a highly significant association between the discrimination of classifiable injury patterns and the different surgical treatments chosen (P < 0.005). The Strasberg and Neuhaus classifications do not consider vascular involvement, whereas the Stewart-Way, Siewert and Neuhaus systems do not discriminate between lesions at or above the bifurcation of the hepatic duct. CONCLUSION Additional vascular involvement and location of the lesion at or above the bifurcation of the hepatic duct have a major impact on the extent of surgical intervention required and should be reflected in any classification of bile duct injuries.
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Affiliation(s)
- H Bektas
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, D-30625 Hanover, Germany.
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Rosenmüller M, Haapamäki MM, Nordin P, Stenlund H, Nilsson E. Cholecystectomy in Sweden 2000-2003: a nationwide study on procedures, patient characteristics, and mortality. BMC Gastroenterol 2007; 7:35. [PMID: 17705871 PMCID: PMC2040147 DOI: 10.1186/1471-230x-7-35] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 08/17/2007] [Indexed: 12/15/2022] Open
Abstract
Background Epidemiological data on characteristics of patients undergoing open or laparoscopic cholecystectomy are limited. In this register study we examined characteristics and mortality of patients who underwent cholecystectomy during hospital stay in Sweden 2000 – 2003. Methods Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden from January 1st 2000 through December 31st 2003. Mortality risk was calculated as standardised mortality ratio (SMR) i.e. observed over expected deaths considering age and gender of the background population. Results During the four years of the study 43072 patients underwent cholecystectomy for benign biliary disease, 31144 (72%) using a laparoscopic technique and 11928 patients (28%) an open procedure (including conversion from laparoscopy). Patients with open cholecystectomy were older than patients with laparoscopic cholecystectomy (59 vs 49 years, p < 0.001), they were more likely to have been admitted to hospital during the year preceding cholecystectomy, and they had more frequently been admitted acutely for cholecystectomy (57% Vs 21%, p < 0.001). The proportion of women was lower in the open cholecystectomy group compared to the laparoscopic group (57% vs 73%, p < 0.001). Hospital stay was 7.9 (8.9) days, mean (SD), for patients with open cholecystectomy and 2.6 (3.3) days for patients with laparoscopic cholecystectomy, p < 0.001. SMR within 90 days of index admission was 3.89 (3.41–4.41) (mean and 95% CI), for patients with open cholecystectomy and 0.73 (0.52–1.01) for patients with laparoscopic cholecystectomy. During this period biliary disease accounted for one third of all deaths in both groups. From 91 to 365 days after index admission, SMR for patients in the open group was 1.01 (0.87–1.16) and for patients in the laparoscopic group 0.56 (0.44–0.69). Conclusion Laparoscopic cholecystectomy is performed on patients having a lower mortality risk than the general Swedish population. Patients with open cholecystectomy are more sick than patients with laparoscopic cholecystectomy, and they have a mortality risk within 90 days of admission for cholecystectomy, which is four times that of the general population. Further efforts to reduce surgical trauma in open biliary surgery are motivated.
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Affiliation(s)
| | | | - Pär Nordin
- Department of Surgery Östersunds Hospital, Östersund, Sweden
| | - Hans Stenlund
- Epidemiology and Public Health Sciences, Umeå International School of Public Health, Sweden
| | - Erik Nilsson
- Department of Surgery, Umeå University Hospital, Sweden
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Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Knipschield MA, Chung S, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Pasricha PJ. Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest Endosc 2007; 65:1028-34. [PMID: 17531637 DOI: 10.1016/j.gie.2007.01.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 01/02/2007] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transgastric cholecystectomy is thought to technically and anatomically challenge a single entry flexible endoscopic approach. OBJECTIVES To examine the feasibility of a transgastric-only cholecystectomy, endoscope performance in an upper-abdominal operation, and the usefulness of an offset gastrotomy. STUDY DESIGN Animal survival study. SETTING Animal research laboratory. PATIENTS Six domestic pigs. MAIN OUTCOME MEASUREMENTS Transgastric access to the gallbladder and technical feasibility of unassisted transgastric cholecystectomy. INTERVENTIONS A cephalad submucosal tunnel was created in the anterior gastric wall with a high-pressure CO2 injection. An EMR-cap myotomy was performed distally within the submucosal space and created an offset gastrotomy. An endoscope was inserted into the peritoneal cavity through the myotomy. Access to the gallbladder was compared by using a multibending therapeutic endoscope (R-scope), with a standard double-channel endoscope. A cholecystectomy was performed by using both types of endoscopes. The myotomy site was sealed with the overlying mucosal flap. The mucosal entry point was closed with clips or tissue anchors. RESULTS A standard double-channel endoscope could access the gallbladder in 2 of 4 attempts. A multibending endoscope accessed the gallbladder in all 4 attempts, including 2 pigs in which the standard scope failed to access the gallbladder. In 4 pigs, a cholecystectomy was completed. Two pigs died during surgery, with air embolization observed in 1. Two pigs survived a planned 1-week survival period. CONCLUSIONS Transgastric cholecystectomy is technically feasible. Transgastric access to the gallbladder may be improved by using submucosal endoscopy with an offset exit gastrotomy by means of the mucosal flap safety-valve technique and a multibending gastroscope.
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Affiliation(s)
- Kazuki Sumiyama
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Passage J, Joshi P, Mullany DV. Acute Cholecystitis Complicating Cardiac Surgery: Case Series Involving More Than 16,000 Patients. Ann Thorac Surg 2007; 83:1096-101. [PMID: 17307465 DOI: 10.1016/j.athoracsur.2006.09.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 09/13/2006] [Accepted: 09/14/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute cholecystitis after cardiac surgery is rare but carries a high mortality. Its management remains controversial. METHODS We reviewed all cases of calculous cholecystitis (CC) and acalculous cholecystitis (ACC) encountered at our institution over the past 11 years. Data collection included preoperative variables, details of performed procedures, postoperative course, and outcome. RESULTS The overall incidence was 0.03% for CC and 0.08% for ACC (5 and 13 of 16,576 patients, respectively). Patients in the ACC group appeared to be sicker patients whereas most patients in the CC group had an uncomplicated recovery from cardiac surgery. The diagnosis was straightforward with typical presentation and ultrasonographic findings in the CC group. In the ACC group, the presentation was less specific, and although useful as diagnostic tool, ultrasonography findings were not as consistent as in the CC group. In the CC group, 3 patients underwent surgery, and 2 patients were treated conservatively. One patient died of cardiac causes after uncomplicated cholecystectomy. In the ACC group, 7 patients were treated medically and 6 patients underwent surgery. The overall mortality was 23% (3 patients). All deaths occurred in patients treated surgically. CONCLUSIONS Given the low incidence of CC, we do not recommend preoperative screening or intervention for cholelithiasis. Treatment should be according to established guidelines. Patients with ACC, without overt peritonitis, should initially be treated conservatively with appropriate antibiotics. However, failure of significant improvement within 48 hours or a worsening clinical picture should lead to surgical intervention.
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Affiliation(s)
- Jurgen Passage
- Department of Cardiac Surgery, Prince Charles Hospital, Chermside, Queensland, Australia.
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Abstract
INTRODUCTION Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. METHODS Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. RESULTS Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. CONCLUSIONS Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity.
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Affiliation(s)
- Sadiq S Sikora
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Balachandran P, Agarwal S, Krishnani N, Pandey CM, Kumar A, Sikora SS, Saxena R, Kapoor VK. Predictors of long-term survival in patients with gallbladder cancer. J Gastrointest Surg 2006; 10:848-54. [PMID: 16769541 DOI: 10.1016/j.gassur.2005.12.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 12/14/2005] [Accepted: 12/14/2005] [Indexed: 02/06/2023]
Abstract
The aim of this study was to examine the predictors of long-term survival (> 24 months) in patients with gall bladder cancer. A retrospective review of 117 cases of gall bladder cancer resected between 1989 and 2000. The resections included 80 simple cholecystectomies and 37 extended procedures. Patients with survival > 24 months (n = 44) were compared with those having survival < 24 months (n = 73) for 17 prognostic factors. Overall median survival was 16 months with a 5-year survival of 27%. T status (P = .000) and adjuvant chemoradiotherapy (P = .001) were independent predictors of long-term survival. Survival advantage was seen in T3N+ve disease (P = .007) with extended procedures. Complete (R0) resection was attained in 30 patients with a 5-year survival advantage of 30% as compared with incomplete (R1) resection (P = .0002). Adjuvant chemoradiotherapy improved survival in simple cholecystectomy group (P = .0008) but no advantage was seen after extended procedures. Stage III (P = .001) and node-positive disease (P = .0005) had significant benefit with adjuvant therapy. Poor differentiation and vascular invasion were associated with poor long-term survival. R0 resection was associated with prolonged survival. Extended procedures improved survival in patients with T3N+ve disease. Addition of chemoradiotherapy made significant improvement in long-term survival in stage III and node-positive lesions and in patients undergoing simple cholecystectomy. R0 resection predicted long-term survival in gall bladder cancer. T3 N+ve disease had better survival after extended procedures. Adjuvant chemoradiotherapy improved survival in stage III and node-positive disease. Poor differentiation and vascular invasion were adverse predictors of survival.
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Affiliation(s)
- Palat Balachandran
- Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
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Diamantis T, Tsigris C, Kiriakopoulos A, Papalambros E, Bramis J, Michail P, Felekouras E, Griniatsos J, Rosenberg T, Kalahanis N, Giannopoulos A, Bakoyiannis C, Bastounis E. Bile duct injuries associated with laparoscopic and open cholecystectomy: an 11-year experience in one institute. Surg Today 2006; 35:841-5. [PMID: 16175465 DOI: 10.1007/s00595-005-3038-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Accepted: 11/16/2004] [Indexed: 01/07/2023]
Abstract
PURPOSE Bile duct injury (BDI) represents the most serious complication of laparoscopic cholecystectomy (LC). The aim of this retrospective single-institution study was to evaluate the real incidence of BDI during laparoscopic and open cholecystectomy (OC) in a tertiary academic center in Athens, Greece. METHODS Between January 1991 and December 2001, 3637 patients underwent cholecystectomy in our department; as LC in 2079 patients (LC group) and as OC in 1558 patients (OC group). All the LCs were performed or supervised by five staff surgeons and all the OCs were performed or supervised by another five staff surgeons. RESULTS There were 13 BDIs associated with LC (0.62%) and 6 associated with OC (0.38%) (P = 0.317). There was one death associated with BDI after LC. Only two (15.4%) of the BDIs associated with LC occurred within the proposed learning curve limit of 50 LCs per individual surgeon. CONCLUSION Laparoscopic cholecystectomy is safe and is not associated with a higher incidence of BDI than OC. Moreover, we did not find that the learning curve for LC affected BDI occurrence.
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Affiliation(s)
- Theodoros Diamantis
- First Surgical Department, Medical School, University of Athens, Laiko Hospital, 17 Aghiou Thoma Street, GR-115-27, Athens, Greece
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Bauhofer A, Lorenz W, Koller M, Menke H, Sessler DI, Sitter H, Celik I, Nies C, Wulf H, Torossian A. Evaluation of the McPeek postoperative outcome score in three trials. Langenbecks Arch Surg 2006; 391:418-27. [PMID: 16463192 DOI: 10.1007/s00423-005-0020-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 12/13/2005] [Indexed: 01/23/2023]
Abstract
BACKGROUND Postoperative outcome of patients is determined by recovery characteristics and self-reported quality of life. The first can be assessed with the McPeek score which values three aspects of recovery: mortality, postoperative critical care and duration of hospitalization. MATERIALS AND METHODS We calculated the McPeek score of 669 patients in three trials: (1) colorectal cancer surgery, (2) antihistamine/volume loading in various operations, and (3) cholecystectomy. Beforehand, the average of intensive care unit treatment and duration of hospitalization were determined for the different operations to define McPeek score points. The score was tested on reliability, validity, and sensitivity. In addition, clinical applicability was assessed in a survey. RESULTS The score was reliable with similarly distributed score points in the three trials at different institutions. Inter-rater reliability was high (97% overlap). Validity was proven by moderate high correlation to convergent criteria such as complications (trial I to III r=0.43, r=0.38, r=0.60), preoperative American Society of Anesthesiologists class (ASA) (r=0.24, r=0.28, r=0.57), and age (r=0.23, r=0.32, r=0.31). The score was different between patients with and without neoplasms (P<0.001, trial II) and between elective or emergency patients (P<0.001, trial III). In a survey, investigators reported that the score was easy to assess and more comprehensive than four other scores. CONCLUSIONS The McPeek score values the postoperative outcome on a nonlinear scale. A priori, the average duration of hospitalization and critical care for a specific operation has to be defined. Our validation suggests that it is a reliable, valid, sensitive, and practical instrument for outcome analysis after anesthesia and surgery.
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Affiliation(s)
- Artur Bauhofer
- Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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Xiao WD, Peng CH, Zhou GW, Wu WD, Shen BY, Yan JQ, Yang WP, Li HW. Surgical treatment for Nevin stage IV and V gallbladder carcinoma: report of 70 cases. Hepatobiliary Pancreat Dis Int 2005; 4:589-92. [PMID: 16286269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of aggressive surgery for end-stage gallbladder carcinoma is controversial. This retrospective study was designed to evaluate the outcome of surgical treatment for Nevin stage IV and V gallbladder carcinoma at a single institution. METHODS A retrospective analysis was made on 70 patients with Nevin stage IV and V gallbladder carcinoma undergoing surgical treatment from January 1993 to June 2004. RESULTS There were 22 cases of stage IV and 48 of stage V. Cholecystectomy was performed in 37 cases with a resection rate of 53%, 9 cases received radical resection, 13 extended radical resection, and 15 palliative resection. The curative resection rate was 31% and the morbidity rate was 36%. Postoperative 1-, 3-, 5-year survival rates of curative and palliative resection were 69%, 33%, 8% and 27%, 13%, 0, respectively (P<0.01). The 1- and 3-year survival rates of patients undergoing exploratory laparotomy only were 3% and 0, respectively. CONCLUSIONS Nevin stage IV and V gallbladder carcinoma should be treated by aggressive surgery. Curative resection is promising in the improvement of long-term survival rate.
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Affiliation(s)
- Wei-Dong Xiao
- Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China
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Bardram L, Rosenberg J, Kristiansen VB. [The Danish Cholecystectomy Database--DCD]. Ugeskr Laeger 2005; 167:2618-20. [PMID: 16014211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A Danish national database has been designed to monitor the quality of cholecystectomies. Data on each operation, surgeon, patient, length of hospital stay and complications are registered prospectively. Hospital departments will periodically be informed of their own and national results and will have continuous access to their own data for further analyses. A report on the nationwide data will be published and debated once a year after a thorough expert evaluation of the results in relation to defined risk factors. The database can be the basis for future clinical development and scientific investigations.
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Affiliation(s)
- Linda Bardram
- Kirurgisk Sektion, Gastroenheden, H:S Hvidovre Hospital.
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Abstract
There is controversy in some aspects of the surgical treatment of non-mucosal gallbladder carcinoma. An accurate staging based on T (wall) involvement is crucial, otherwise understanding may yield falsely pessimistic results. The decision about the type of resection to be performed should be based on patient status (age, performance, comorbidities, etc) and tumor characteristics (histological type, vascular, neural or lymphatic spread, cell differentiation, tumor involvement of surgical margins in cystic duct, etc). For muscular (T1b) involvement, there is a great controversy about performing a simple cholecystectomy or en-block radical resection. For T2 there is consensus that an en-block radical surgery including liver resection (IVb - V) and lymphonodal clearance should be performed, since this approach has a great impact in survival. The role of surgical excision for tumors with serosal or liver involvement is controversial, due to the poor survival of these patients. However we have observed a 13% actuarial survival at 5 years, in this subset of patients.
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Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H. Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol 2005; 30:842-6. [PMID: 15336729 DOI: 10.1016/j.ejso.2004.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2004] [Indexed: 09/30/2022] Open
Abstract
AIM Survival and prognostic factors were analysed in patients who had undergone surgical resection with curative intention with the aim of identifying groups of patient with stage III and IV gallbladder cancer on the TNM classification who might benefit from surgery. METHODS Thirty-seven patients with advanced gallbladder cancer were studied, the cumulative survival rate for each group was calculated for each pTNM factor. RESULTS The 5-year survival rates in the stage III patients were 83.3%, while those for the stage IVA patients were 46.2%, and those for the stage IVB patients 16.7%. CONCLUSIONS In patients with invasion of adjacent organs, including the liver and gastrointestinal tract, and rated as pT3 or pT4, extended surgery excising the invaded tissue may be justified. In patients with pN2 lymph-node metastasis, even without adjacent organ invasion, radical surgery may not achieve a good outcome.
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Affiliation(s)
- H Wakabayashi
- Department of Surgery, Sakaide Municipal General Hospital, Sakaide-city, Kagawa 762-0031, Japan.
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42
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Abstract
BACKGROUND & AIMS Patients with cirrhosis have an increased risk for cholelithiasis but also have an increased risk for morbidity and mortality after cholecystectomy. Current preoperative assessment of surgical risk is imprecise. Our aims were to identify preoperative factors that would accurately predict the risk for cholecystectomy in patients with cirrhosis. METHODS Preoperative clinical or biochemical parameters were determined for 33 patients with cirrhosis and 31 age- and sex-matched patients without cirrhosis. The use of these parameters and of the Child-Pugh and model for end-stage liver disease (MELD) scores as preoperative predictors of outcome after surgery were assessed. RESULTS There were 2 deaths, both in cirrhotic patients. The overall risk for morbidity or mortality was increased in cirrhotic patients compared with controls. Postoperative morbidity was significantly associated with preoperative increases of international normalized ratio >1.2, bilirubin >1.0 mg/dL, creatinine >1.4 mg/dL, and a decreased platelet count <150 x 10(3) /mL. The MELD and Child-Pugh scores accurately predicted postoperative morbidity, with an area under the curve of 0.938 and 0.839, respectively. A preoperative MELD score of > or =8 had a sensitivity of 91% and a specificity of 77% for predicting postoperative morbidity. Persons with a MELD score of > or =8 had increased 30- and 90-day global charges and increased blood product usage. CONCLUSIONS Preoperative biochemical parameters, international normalized ratio, bilirubin, platelets, and creatinine can predict increased morbidity in cirrhotic patients. A MELD score of > or =8 identifies a group at high risk for postoperative morbidity after cholecystectomy.
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Affiliation(s)
- Linda Perkins
- division of Gastroenterology, Scott and White Clinic, Texas A&M University System Health Science Center, Temple, Texas 76508, USA
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43
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Terpstra OT. [Bile duct injury after cholecystectomy: risk of mortality substantially higher]. Ned Tijdschr Geneeskd 2004; 148:2148; author reply 2149. [PMID: 15553362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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44
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Abstract
BACKGROUND Gallbladder cancer is the leading cause of death of cancer among women in Chile. Detection of early forms of the disease during the pathological study of the cholecystectomy specimen is common. The management of these cases, specially those with invasion of the muscular layer is under discussion. AIM To analyze the clinical features of patients with gallbladder cancer and muscular layer invasion and their prognosis after a simple cholecystectomy. PATIENTS AND METHODS We studied a series of 46 patients with gallbladder cancer and invasion of the muscular layer. In the majority of cases diagnosis was performed at the moment of specimen study. Eleven patients underwent reoperation. Of these, ten underwent lymphadenectomy and liver resection while one patient underwent resection of the cystic duct stump. RESULTS During follow up, five patients died as a consequence of gallbladder cancer. Overall survival was 78%, with no differences between patients subjected or not a new operation. CONCLUSIONS Gallbladder cancer with muscular infiltration has a good prognosis, independent of the type of therapy.
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Gouma DJ, Rauws EA, Laméris JS. [Bile duct injury after cholecystectomy: risk of mortality substantially higher]. Ned Tijdschr Geneeskd 2004; 148:1020-4. [PMID: 15185435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Previous studies showed that bile duct injury after cholecystectomy is associated with substantial morbidity and a negative effect on Quality of Life. In a recent study, patients with a bile duct injury after cholecystectomy exhibited a 3-fold increase in mortality during a follow-up period of nine years compared to patients without injury. This is the first study to demonstrate a negative impact of bile duct injury on survival. Repair by a less experienced surgeon leads to an 11% higher mortality during follow-up. Cholangiography should probably be performed routinely during cholecystectomy. A bile duct lesion should be suspected when the patient has not recovered within 48 hours. Endoscopic or percutaneous treatment of stenoses or leakage is usually successful, even after several weeks.
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Affiliation(s)
- D J Gouma
- Afd. Algemene Chirurgie, Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.
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46
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Abstract
OBJECTIVE To determine long-term outcome of dogs with gallbladder mucocele. DESIGN Retrospective study. ANIMALS 30 dogs with gallbladder mucocele, including 23 that underwent cholecystectomy. PROCEDURE Medical records were reviewed for signalment, history, and clinical, ultrasonographic, and surgical findings. Follow-up information was obtained for all dogs that survived the perioperative hospitalization period. RESULTS 23 dogs had signs of systemic illness; 7 had no clinical signs. Median values for serum activities of alanine aminotransferase and alkaline phosphatase, serum total bilirubin concentration, and total WBC count were significantly higher among dogs with gallbladder rupture than among dogs without rupture. Sensitivity of sonography for detection of rupture was 85.7%. Overall perioperative mortality rate for dogs that underwent cholecystectomy was 21.7%; mortality rate was not significantly greater for dogs with rupture. Aerobic bacteria were isolated from the bile or gallbladder wall in 8.7% of dogs. All 18 dogs discharged from the hospital had complete resolution of clinical signs. In dogs that underwent in-hospital reexamination, serum liver enzyme activities were significantly decreased, compared with preoperative activities. Persistent increases in serum activities of 1 or more liver enzymes were detected in 9 of 12 dogs; 6 of 12 dogs had persistent abnormalities in hepatic echogenicity. Mean follow-up period was 13.9 months. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that cholecystectomy is an effective treatment for gallbladder mucocele. Although perioperative mortality rate is high, prognosis after discharge from the hospital is excellent. Rupture of the gallbladder warrants emergency surgical intervention but does not preclude a positive outcome.
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Affiliation(s)
- Fred S Pike
- Department of Clinical Sciences, School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
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Khan HN. Re: Asymptomatic gallstones in the laparoscopic era. JR Coll Surg Edin 2002; 14: 742-748. Surgeon 2004; 2:115; author reply 116. [PMID: 15568438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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48
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Zhang BH, Yi B, Peng LH, Zhang BH, Jiang XQ, Wu MC. The relationship between surgery and prognosis of gallbladder carcinoma. Hepatobiliary Pancreat Dis Int 2003; 2:581-6. [PMID: 14627524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the prognostic factors of gallbladder carcinoma and the relationship between operative procedure and prognosis of gallbladder carcinoma. METHOD A retrospective clinical analysis was made in 56 patients with gallbladder carcinoma who had undergone surgery at our department from 1995 to 2001. RESULTS Of the 56 patients, 20 were men and 36 women with a male to female ratio of 1:1.56. Their age ranged from 41 to 79 years with a mean of 59.6 years. Thirty-four patients suffered from gallstones. Abdominal pain (83.9%) and jaundice (41.1%) were the main symptoms. Thirty patients (Nevin stage II in 5 patients, III in 3, IV in 4, and V in 18) received radical or extended radical resection; non-radical resection was performed in 11 patients of Nevin stage V; and 15 patients of Nevin stage V were subjected to biopsy with or without palliative bypass procedure. Statistical analysis showed that operative procedure, staging of Nevin, and gallstone affected significantly postoperative survival, but age, sex, preoperative serum bilirubin level, numbers of tumor location, histopathological type and grade were not significant prognostic factors. After radical resection was classified with Nevin staging, we found that all the patients of stage II were alive. Meanwhile the postoperative survival periods of radical resection groups of stage III to V, palliative resection group, and biopsy with/without palliative drainage group were statistically different. CONCLUSIONS From Nevin stage II to V, the survival period of respective stage group, which treated with curative operation, became shorter gradually. In those patients of stage V, the survival period of curative operation group was longer than that of palliative resection group, and that of the latter was better than that of biopsy with/without palliative drainage group. So radical resection was still the unique way to better prognosis.
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Affiliation(s)
- Bai-He Zhang
- Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China.
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Kuznetsov NA, Aronov LS, Kharitonov SV, Brontvein AT, Ziniakova MV. [Choice of the policy, terms, and method of surgery in acute cholecystitis]. Khirurgiia (Mosk) 2003:35-40. [PMID: 12792959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Results of treatment of 763 patients with different forms of cholecystitis were analyzed. It was revealed that complex ultrasonic examination with dopplerography identifies the form of acute cholecystitis, allows to, predict technical difficulties in cholecystectomy and define optimum method of surgery. Comparative assessment of time of surgeries, rate of conversion of surgical approach, number of intra- and postoperative complications, lethality demonstrated that early urgent surgeries in acute cholecystitis before formation of inflammatory paravesical infiltrate in patients without high anesthesiological risk were similar to ones in elective surgeries and surpassed results of delayed surgeries. Early urgent surgeries permit to decrease hospital stay of patients with acute cholecystitis and reduce cost of treatment.
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50
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Abstract
OBJECTIVE To review the outcome of cholecystectomy after heart transplant. SUMMARY BACKGROUND DATA The optimal timing for gallbladder surgery in heart transplant patients is controversial. METHODS Between April 1985 and October 2000, 518 cardiac transplants were performed at Ochsner Foundation Hospital. Data gathered included ultrasound reports, cholecystectomy operative reports, gallbladder pathologic reports, complications, and deaths. RESULTS Charts were available for 509 patients (98%), 68 (13%) of whom underwent cholecystectomy before transplantation. Of the 509, 53 (10%) had serial ultrasound examinations and 29 of the 53 (55%) developed gallstones. After transplant, 47 (9%) underwent cholecystectomy. Five cholecystectomies were performed during the immediate postoperative course. Two patients who underwent cholecystectomy had acalculous cholecystitis; one was incidental. Four patients died (one with rejection and three with sepsis). After discharge, 42 cholecystectomies were performed: 16 for biliary colic (no deaths, three patients with complications), 19 for acute cholecystitis (one death, nine patients with complications), 5 for biliary pancreatitis (1 death, 1 patient with complications), and 2 others. CONCLUSIONS The risk of morbidity and mortality from gallstone disease is high in cardiac transplant patients, particularly immediately posttransplant. Posttransplant patients require annual ultrasound examinations to detect the onset of gallstone disease, and this risk is higher than in the general population. Gallstones alone are an indication for cholecystectomy in the cardiac transplant patient. Pretransplant cholecystectomy should be considered in clinically stable patients with gallstones.
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