Abstract
A therapeutic strategy for early cancer of the gallbladder was investigated on the basis of itszpathological characteristics. Ninety-five patients who had carcinomas confined to the mucosa or proper muscle layer of the gallbladder were studied. About 60% of the early cancers showed superficial elevated or flat type lesions and only 7.2% (11.1% in IIa and 3.6% in IIb) of these lesions were detected preoperatively. The importance of intraoperative macroscopic examination of the specimen during cholecystectomy was confirmed. Radical cholecystectomy was performed in 27 patients and simple cholecystectomy in the remaining 68 patients. However, there were no deaths from recurrence within 5 years. Only two patients, who had positive margins of the cystic duct, died of recurrence more than 5 years postoperatively. All lymph nodes removed from the 27 patients who underwent radical cholecystectomy were examinded histologically. No lymph node involvement was observed. It is difficult to differenciate early from advanced cancer. Therefore, even when a cancer is suspected to be in the early stage from preoperative or intraoperative examination, it is recommended that radical cholecystectomy be performed. In the case of pedunculated polypoid carcinoma, cholecystectomy with resection of first-station lymph nodes is indicated. When early cancer is diagnosed by histological examination, a second look operation is not necessary in the case of mucosal cancer, if the cut margin is negative. A second look operation is recommended for cancer extending to the proper muscle layer.
