[Gallbladder carcinoma. Personal case histories]

Carcinoma of the gallbladder is a rare pathology which is extremely malignant with a fatal prognosis owing to its difficult and late diagnosis. It represents 3% of all digestive tumours and is predominant in females. The major risk factor is gallbladder stones.

A total of 14 gallbladder neoplasms were diagnosed in 798 cholecystectomies performed from October 1990 to October 1995, with a male/female ratio of 6: 1 and a mean age of 68 years and 11 months. Biliary colic and jaundice represented approximately 93% of symptoms present in this series. Fourteen cholecystectomies were performed in association with other forms of surgery (1 GEA, 2 drainage acc. Kehr, 1 hemicolectomy, 1 resection of the hepatic bed, 1 hepaticojejunostomy).

The operative mortality was nil. Mean survival was 1 year, 4 months and 15 days, and was obviously higher in the early stages. Four patients (all female) are still alive (mean survival 2 years 10 months 9 days). The five-year survival rate reported in the literature does not exceed 5-10%. Surgery does not currently give satisfactory results. In the light of present knowledge it is important to intervene on the risk factors in the form of laparoscopic cholecystectomies for patients with lithiasis or gallbladder polyps.

Diagnosis must be as early as possible during the "early cancer" phase in order to ensure that surgery is oncologically radical and therefore also remedial.