AN APPROACH TO HISTOLOGICALLY DIAGNOSED GALLBLADDER CARCINOMA FOLLOWING CHOLECYSTECTOMY FOR PRESUMED BENIGN DISEASE

Five cases of gallbladder adenocarcinoma treated at Surgical Departmen t 2, Maciel Hospital, Montevideo, Uruguay, in a period ranging from 19 85 to 1989 and follow-up to date are reported. All cases were first di agnosed by microscopic examination of the gallbladder, which had been removed for presumed benign disease; there were no intramucosal carcin omas, and 60% of the cases were classified as Nevin's stage II (submuc osal and muscularis). Based on the pattern of spread (mainly direct he patic infiltration, as well as venous and lymphatic involvement), our radical surgical treatment of gallbladder carcinoma includes cholecyst ectomy, extended lymphatic clearance (along the porta hepatis or R1, p re- and retroduodenopancreatic and hepatic artery R2, and celiac axis R3), and medial hepatectomy (segments, IV, V, and VIII according to Co uinaud). Simple cholecystectomy is the treatment of choice in mucosal (T1) neoplasms; otherwise, histologically diagnosed gallbladder carcin oma following cholecystectomy for presumed benign disease calls for re operation to achieve lymph node dissection and hepatic resection. Over all 2- and 3-year survival was 100% and 80%; mean survival was 50 mont hs. Medial hepatectomy was selected according to gallbladder carcinoma patterns of spread and failures, and entails resection of the parench yma most frequently involved without compromising liver function, in a quick and safe surgical procedure.