Primary carcinoma of the gallbladder.

Data from 6,222 patients with primary carcinoma of the gallbladder reported upon in the past 15 years have been analyzed. The disease occurs predominately in elderly females who often present with extremes of clinical symptoms, suggesting, on one hand, benign calculous disease or, on the other, advanced incurable malignant disease. Laboratory and x-ray data tend to confirm the clinical diagnosis of incurable disease, but do not aid in determining those patients with early, potentially curable lesions. The biologic nature of the tumor makes most carcinomas unsuspected findings at the time of operation and limits those patients presenting with resectable disease to about 25 per cent. The over-all five year survival of patients with carcinoma of the gallbladder is only 4.1 per cent. Furthermore, virtually the only survivors are those with lesions resected early that were not apparent to the operating surgeon and of the papillary cell type without significant invasion of the wall of the gallbladder. If the tumor is recognized and believed to be resected, survival is only 2.9 per cent, with failures caused by locally recurrent tumor. Despite the obvious failure of management of carcinoma of the gallbladder, therapeutic advantage has not been taken of the tumor's propensity to remain locally invasive by extending the scope of the traditional cholecystectomy to include en bloc hepatic wedge resection and regional lymphadenectomy in treating patients with recognized malignant tumors. Reoperation for delayed hepatic resection and lymph node dissection should be considered in selected patients with carcinoma unsuspected at operation but noted in the resected specimen. Selected application of this approach might offer the chance of cure to a small, but definite, group of patients who are currently being undertreated.