POOR-PROGNOSIS OF GALLBLADDER CANCER PERSISTS REGARDLESS OF IMPROVED DIAGNOSTIC METHODS - INCIDENCE AND RESULTS OF SURGERY DURING 20 YEARS IN HELSINKI

Background and aims: The ominous prognosis of primary gallbladder canc er is well-known. This study assesses whether the prognosis has improv ed, and whether the substantial development in the radiologic imaging techniques is reflected in the survival of these patients. Material an d methods: The series consisted of 122 patients operated on for primar y cancer in the gallbladder in the Helsinki City area between 1970 and 1990. Results: The mean age of the patients was 68.6 years and did no t change during the period, but there was a significant proportional i ncrease in male patients. Only 2% of patients had a localized disease at the time of diagnosis, and there was no improvement in the diagnost ic sensitivity during the observation period. Yet, the number of unexp ected postoperative cancer diagnoses increased from 4 % to 15 % during the two decades. The primary mortality decreased from 21 % to 13 %, t he one-year survival increased from 7 % to 13 %, whereas the five-year survival remained unchanged. Conclusions: During the past two decades the frequency of surgery for primary gallbladder cancer has increased significantly among males in the Helsinki City area. Regardless of th e improved immediate survival the long-term survival has remained poor . The marked development in radiologic techniques is not reflected in the prognosis of these patients. Even under conditions in which the po tential for the diagnosis of a malignant gallbladder disease is availa ble, the opportunities for radical surgery are not utilized maximally, which is a cause for concern.