Objective: To investigate the efficacy and safety of enhanced recovery after surgery (ERAS) in perioperative management of patients with gallbladder carcinoma. Methods: The data of the patients with gallbladder carcinoma admitted at Peking Union Medical College Hospital between January 2017 and December 2021 were analyzed retrospectively. There were 69 males(42.1%) and 95 females(57.9%),with age of (64.0±10.3) years(range:37 to 89 years). Patients were divided into ERAS group(n=53) and normal group(n=111) according to whether they were treated with ERAS measures during the perioperative period.The basic characteristics of the two groups were matched by propensity score matching,and then the perioperative information was compared between the two groups. Categorical variables were presented as absolute numbers or frequencies. Differences between study groups were analyzed using χ² test, Fisher's exact test, t-test, or Mann-Whitney U test, as appropriate. Results: Each group had 45 patients after propensity score matching with well-balanced basic characteristics. There was no difference in basic characteristics, operation time,bleeding,complication,and hospitalization expenses between two groups(all P>0.05). Compared with the normal group,time of ambulation (M(IQR)) (1(1) day vs. 2(2) days;Z=-3.839,P<0.01),postoperative anal exhaust time (2(1) days vs. 3(1) days;Z=-3.013,P=0.003),feeding time(2(1) days vs. 2(1) days;Z=-3.647,P<0.01),postoperative (5(2) days vs. 7(4) days;Z=-3.984,P<0.01) and total(8(4) days vs. 13(6) days;Z=-3.605,P<0.01) hospitalization time were shorter in ERAS group. Postoperative complications occurred in 12 patients. According to the Clavien-Dindo classification,6,4,and 2 patients were classified as grade Ⅰ,Ⅱ,and Ⅲa,respectively. Conclusion: The ERAS measures is safe and effective for perioperative management of patients with gallbladder carcinoma, enhancing patient recovery and shortening hospitalization time without increasing complication or hospitalization cost.
Adult ; Aged ; Aged, 80 and over ; Enhanced Recovery After Surgery ; Female ; Gallbladder Neoplasms/surgery* ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Propensity Score ; Retrospective Studies ; Treatment Outcome

Female ; Gallbladder Neoplasms ; complications ; Humans ; Middle Aged ; Skin Neoplasms ; secondary

No abstract available.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Colonoscopy ; Ethanol/therapeutic use ; Female ; Gallbladder Neoplasms/*complications/*diagnosis/pathology ; Humans ; Intestinal Obstruction/*etiology ; Liver Neoplasms/complications/drug therapy/secondary ; Tomography, X-Ray Computed

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
Blood Transfusion ; Body Mass Index ; Chemotherapy, Adjuvant ; Cohort Studies ; Comorbidity ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Lymph Nodes ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

OBJECTIVE: To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. MATERIALS AND METHODS: During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. RESULTS: Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. CONCLUSION: Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.
Adult ; Aged ; Aged, 80 and over ; *Alloys ; Bile Duct Neoplasms/*complications ; Cholangiocarcinoma/*complications ; Cholestasis, Intrahepatic/etiology/*therapy ; Drainage/*instrumentation ; Female ; Gallbladder Neoplasms/complications ; Humans ; Male ; Middle Aged ; *Palliative Care ; *Stents

Obesity is an important health problem in the world and related to many critical diseases, such as diabetes, cardiovascular disease, and metabolic syndrome. Obesity leads to fat infiltration of multiple organs and infiltrated adipose tissue produces many cytokines resulting in the dysfunction of organs such as the gallbladder. In the biliary diseases, obesity and overweight have been known as a major risk factor for gallstones. According to current studies, obesity, insulin resistance, hyperinsulinemia, and metabolic syndrome are related to various gallbladder diseases including gallbladder stones, cholecystitis, gallbladder polyps, and gallbladder cancers. We reviewed further literature on the obesity and gallbladder diseases, in aspects of epidemiology, mechanism, pathology and prevention.
Body Mass Index ; Cholecystitis/etiology ; Exercise ; Gallbladder Diseases/drug therapy/epidemiology/*etiology/prevention & control ; Gallbladder Neoplasms/epidemiology/etiology ; Gallstones/epidemiology/etiology ; Humans ; Hyperinsulinism ; Hypolipidemic Agents/therapeutic use ; Insulin Resistance ; Obesity/*complications ; Ursodeoxycholic Acid/therapeutic use ; Weight Loss

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.
Adenocarcinoma/*complications/radiography/secondary/surgery ; Aged ; Aortic Aneurysm, Abdominal/*complications/radiography/surgery ; Biopsy ; Blood Vessel Prosthesis Implantation ; Cholecystectomy ; Cholecystitis/*complications/pathology/radiography/surgery ; Endovascular Procedures ; Female ; Gallbladder Neoplasms/*complications/pathology/radiography/surgery ; Granuloma/*complications/pathology/radiography/surgery ; Humans ; Tomography, X-Ray Computed ; Treatment Outcome ; Xanthomatosis/*complications/pathology/radiography/surgery

BACKGROUND/AIMS: CyberKnife(TM) stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnife(TM) treatment have not been established yet, so we report the experience of CyberKnife(TM) treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies. METHODS: Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnife(TM) treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT. RESULTS: The mean age was 60.2 years, and the mean size of target lesions was 28.1+/-1.30 mm. After CyberKnife(TM) treatment, the average size of target lesions was decreased; 2.53+/-4.18 mm from months 0-1 in 19 patients, 2.47+/-4.7 mm from months 1-3 in 15 patients, 0.08+/-5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67+/-8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnife(TM) treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea. CONCLUSIONS: CyberKnife(TM) treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of Cyberknife(TM) treatment in patients with advanced pancreaticobiliary malignancies.
Adult ; Aged ; CA-19-9 Antigen/analysis ; Common Bile Duct Neoplasms/complications/pathology/*surgery ; Female ; Gallbladder Neoplasms/complications/pathology/*surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/pathology/*surgery ; Radiosurgery ; Retrospective Studies ; Tomography, X-Ray Computed

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
Bile Ducts, Extrahepatic ; Biliary Tract Diseases/complications/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenal Diseases/*diagnosis/etiology/therapy ; Female ; Gallbladder Neoplasms/diagnosis ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Plastics ; Stents/*adverse effects ; Tomography, X-Ray Computed

BACKGROUND/AIMS: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens. METHODS: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma-related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared. RESULTS: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas. CONCLUSIONS: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis.
Adenoma/epidemiology/*pathology/surgery ; Adult ; Age Factors ; Aged ; Carcinoma/epidemiology/pathology/surgery ; Cell Transformation, Neoplastic ; Cholecystectomy ; Cystadenoma/epidemiology/pathology/surgery ; Female ; Gallbladder Neoplasms/epidemiology/*pathology/surgery ; Gallstones/complications ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness