[Hope for cure of gallbladder cancer. Arguments for a new concept of early stages]

The study of 20 personal cases and 254 cases collected by a meeting of surgeons reveals contradictory results from surgical treatment. The peculiar structure of the wall and the bipolar relations with the liver and vessels (especially lymphatics) are the basis for the nosological and therapeutic deductions. Personal observation and a review of the literature show that there is an increasing possibility for cure based on the following classification: --the macroscopic stage described as "early" is in fact already invasive and requires major liver resection and wide lymph node excision; --the early stage is dangerous because the lesion involves the whole thickness of the mucosa. It is only recognizable on histology and it requires extension of the cholecystectomy to include liver and lymph nodes which results in long survivals; --the "in situ" stage, a purely epithelial lesion, is diagnosed on cytology and can be cured with simple cholecystectomy. Prevention of cancer of the gallbladder depends on a broader indication for cholecystectomy (stones, females, older than 55).