Abstract
The aim of this study was to clarify whether a close macroscopic examination can detect gallbladder carcinoma (GBC) in the resected specimen intraoperatively, and can contribute to improving prognosis. In our series of 318 GBC's, we found 63 GBC's at the time of operation in that way. Of these 63 patients, 18 had early GBC and 33 had advanced GBC showing subserosal invasion (GBC-ss). The factors that made the preoperative diagnosis difficult were inability to detect lesions by US or X-ray examination, coexistent acute cholecystitis, gallstones, and debris. Operative procedures included 30 simple cholecystectomies, 4 standard radical cholecystectomies (SRC), 15 modified SRC, and 2 other procedures. The 5-year postoperative survival rate for patients with early GBC was excellent. There was a significant difference in 5-year survival rate for the patients with GBC-ss between simple cholecystectomy (31%), and either modified SRC or SRC (88%). These results suggest that it is mandatory to examine the mucosa of the resected gallbladder and diagnose GBC at the time of operation, and that a radical operation or re-operation for GBCs after close pathological examination is indispensable for good prognosis.
