GALLBLADDER CANCER WITH A LOW JUNCTION OF THE CYSTIC DUCT OR AN ANOMALOUS PANCREATICOBILIARY JUNCTION

Objective: To evaluate conditions similar to those of carcinogenesis o f the gallbladder between the gallbladder with a low junction of the c ystic duct (LJCD) and an anomalous pancreaticobiliary junction (APBJ). Design: Retrospective and clinicopathological analysis of patients wi th gallbladder carcinoma. Setting: First Department of Surgery, Kansai Medical University. Patients: Examination of 47 patients (7 men and 4 0 women; average age: 67.8 years) with gallbladder carcinoma revealed 7 patients (14.9%; 1 man and 6 women; average age: 67.8 years) with LJ CD and 6 patients (12.8%; 6 women; average age: 60.3 years) with APBJ. Methods: Clinical findings in both groups were compared with those of the 34 patients who remained after exclusion of the data of the above 7 patients with LJCD and 6 patients with APBJ. The data of the three groups were examined by the chi(2) test at the 5% level of significanc e. Results: Most of the gallbladder cancer patients with LJCD or APBJ had gallstones. The biliary amylase levels determined in the gallbladd er of patients with LJCD or APBJ were remarkably high. Conclusion: The results indicate that patients with LJCD or APBJ are more likely to d evelop carcinoma of the gallbladder. The factors responsible for carci nogenesis may be alteration of the bile content due to reflux of pancr eatic enzymes through the LJCD or APBJ, and mechanical irritation due to gallstones. Therefore, these pathological conditions in patients wi th LJCD are similar to those experienced in patients with APBJ.