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Background. Definitive criteria for choosing the most appropriate treatment for each type of
polypoid lesion of the gallbladder (PLG) have yet to be established.
Methods. The shapes, sizes, echo patterns, and echogenicities of PLGs that had been evaluated
by means of ultrasonography in 72 patients who had undergone resective surgery were
analyzed retrospectively to elucidate the ultrasonic characteristics of polypoid cancers
and to establish criteria for selecting the most suitable treatment such as laparoscopic
cholecystectomy for each type of PLG.
Results. Histologic examinations showed cholesterol polyps in 47 patients, adenomas in 8,
cancers in 16, and an inflammatory polyp in 1. The diameters of 61% of the benign
PLGs were less than 10 mm, whereas those of 88% of the cancers were more than 10 mm;
80% of the former were pedunculated and 56% of the latter were sessile. Seven of eight
early-stage cancers had diameters less than 18 mm, whereas those of all eight more
advanced cancers were greater than 18 mm. Five of the eight early-stage cancers were
pedunculated, and six of the eight more advanced cancers were sessile. Cholecystectomy
with or without full-thickness dissection were main surgical procedures used to resect
benign PLGs and early-stage cancers, whereas cholecystectomy with partial liver resection
was used for more advanced cancers. Laparoscopic cholecystectomy was performed in
the recent 34 patients, four of whom had early-stage cancers.
Conclusions. A PLG with a diameter of less than 18 mm is a potential early-stage cancer and therefore
can be resected by laparoscopic cholecystectomy with full-thickness dissection. However,
when cancer invades the subserosal layer or beyond, a second-look operation is necessary.
A PLG with a diameter of greater than 18 mm may be an advanced cancer and should be
removed by using cholecystectomy with partial liver resection or a more extended procedure
with lymph node dissection.
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References
- Preoperative diagnosis and its effect on the treatment of carcinoma of the gallbladder.Surg Gynecol Obstet. 1983; 159: 456-470
- Ultrasound in elective biliary tract surgery.Am J Surg. 1980; 140: 277-283
- Early carcinoma of the gallbladder: macroscopic features and US findings.Radiology. 1991; 179: 171-175
- Carcinoma of the gallbladder: staging, treatment, and prognosis.Cancer. 1976; 37: 141-148
- Primary gallbladder carcinoma: significance of subserosal lesions and results of aggressive surgical treatment and adjuvant chemotherapy.Surgery. 1983; 94: 705-714
- The surgical treatment for carcinoma of the gallbladder—rationale of the second-look operation for inapparent carcinoma.Jpn J Surg. 1987; 17: 478-486
- Clinicopathological study of polypoid lesions of the gallbladder.Surgery. 1983; 13 ([in Japanese]): 1499-1506
- Treatment of polypoid lesions of the gallbladder.Surgery. 1983; 13 ([in Japanese]): 1515-1519
- Benign tumors and pseudotumors of the gallbladder: review of 180 cases.Arch Pathol Lab Med. 1970; 90: 423-432
- Role of laparoscopic cholecystectomy in treating gallbladder polyps.Surg Endosc. 1994; 8: 42-46
- Gallbladder and extrahepatic bile ducts.in: Ackerman's surgical pathology. The CV Mosby Company, St. Louis1981: 645-663
- Gallbladder carcinoma first diagnosed at microscopic examinations of gallbladders removed for presumed benign disease.Ann Surg. 1980; 191: 19-22
- Carcinoma of the gallbladder: a clinicopathology of 103 patients and a newly proposed staging.Cancer. 1988; 62: 1425-1432
- Early carcinoma of the gallbladder—pathological characteristics and surgical strategy.Jpn J Gastroenterol Surg. 1992; 25 ([in Japanese]): 178-182
- Inapparent carcinoma of the gallbladder: an appraisal of a radical second look operation after simple cholecystectomy.Ann Surg. 1992; 215: 326-331
- Diagnosis and operative indications for polypoid lesions of the gallbladder.Arch Surg. 1988; 123: 26-29
- The difference in malignancy between pedunculated and sessile polypoid lesions of the gallbladder.Am J Gastroenterol. 1988; 84: 1386-1390
- Relation of adenoma to carcinoma in the gallbladder.Cancer. 1982; 50: 2226-2234
- Ultrasonic diagnosis of primary carcinoma of the gallbladder: a review of 16 cases.J Clin Ultrasound. 1980; 8: 489-495
- Is carcinoma of the gallbladder a curable lesions?.Ann Surg. 1980; 195: 624-631
- Carcinoma in situ of the gallbladder.South Med J. 1975; 68: 297-300
Article info
Publication history
Accepted:
September 22,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
