[Difficulties of diagnosis and surgical treatment in gallbladder cancer]

After a review of the etiopathogenic data, as well as of anatomo-pathologic aspects of the cancers of the gall-bladder the authors stress the difficulties of diagnosis encountered in the pre-surgery stage, and during the surgical intervention. In view of an early detection of neoplastic lesions the authors suggest extemporaneous histo-pathogenic examination of the lithiasic gall-bladder. They prefer the transparietal-hepatic cholangiography, and the intraoperative transhepatic cholangiography for an exact assessment of the convergence point of hepatic canals, with a view to perform peripheral hepato-digestive derivations. In the 90 cases of cancers of the gall-bladder, of which 75 (87%) were associated (with 4 deaths), cholecystectomy with atypical hepatectomy in one case, cholecystectomy with choledochs drainage in 4 cases (with one death), cholecystectomy with choledochal-duodenostomy in 2 cases, cholecystectomy in 18 cases (with 3 deaths), cholecysto-gastrostomy in 2 cases, hepato-gastronstomy in 13 cases (with 3 deaths), hepato-cholangio-jejunostomy in 2 cases, and exploratory laparotomy in 35 cases. In view of prophylaxis of gall-bladder cancer the authors suggest that cholecystic lithiasis in patients over the age of 40 years should be treated by cholecystectomy.