Tumores malignos primários da vesícula biliar: estudo de 40 casos

Abstract

The author analyses 40 patients bearing primary malignant tumor of the gall'bladder, in the Surgery Department (."Serviço de Cirurgia Geral - Hospital Universitário Clementi- no Fraga Filho"! of the "Universidade Federal do Rio de Janei- ro" Medicai School, from March 15"", 1978, to December 31"", 1989, consisting of 1,9% of the number of surgical interven- tions on the extrahepatic biliary ducts. The ages ranged from 34 to 88 years old, with an average of 59,5 years old. They were more frequent in females (.39 cases - 97,5%1, white (.31 cases - 77,5%). and married (_50,0%)_. The gall'bladder cancer is a rare affection having an unfavorable biological behavior, clinical course and therapeutic possibilities. The most frequently found histological pattern was adenocarcinoma (37 cases - 92,5%). Advanced lesions Cstage VI were predominant (32 cases - 80,0%). The most frequent signs and symptoms were abdominal pain (35 cases - 87,5%í, weight loss (.31 cases - 77,5%) and jaundice (.21 cases - 52,2%1. Symptoms lasted from ten days to 30 years. Preoperative diagnosis of gall'bladder cancer was done in only four cases (.10,0%), who were not sub- jected to surgical treatment. The abdominal ultrasonography was carried out in 22 cases C55,0%)_, with a suspicion or diagnosis of gall'bladder cancer in ten cases (45,5%). The abdominal computerized tomography was of real value and, in two cases, it counterindicated surgical treatment, due to the disease advanced stage. The predominant accompanying affec- tion in our study was cholelithiasis (28 cases - 70,Q%1. The used surgical procedures were many and varied, according to xi the disease progress. Iinmediate po&t-operatiye complications occurred in 44,4% of the patients and late ones in 23,3%. The patient survival ranged from six days to three years, seven months and 22 days, the average survival being significantly low C5,5 months), and the five year survival null. The one year global survival, according to KAPLAN & METER method, was 15,0%.