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Differentiation between gallbladder cancer with acute cholecystitis: Considerations for surgeons during emergency cholecystectomy, a cohort study

Authors
 Sung Hoon Kim  ;  Dawn Jung  ;  Jhii-Hyun Ahn  ;  Kyung Sik Kim 
Citation
 INTERNATIONAL JOURNAL OF SURGERY, Vol.45 : 1-7, 2017 
Journal Title
 INTERNATIONAL JOURNAL OF SURGERY 
ISSN
 1743-9191 
Issue Date
2017
MeSH
Aged ; Aged, 80 and over ; C-Reactive Protein/analysis ; Carcinoma/diagnosis* ; Carcinoma/surgery ; Cholecystectomy/methods* ; Cholecystitis, Acute/diagnosis* ; Cholecystitis, Acute/surgery ; Cholecystolithiasis/diagnosis* ; Cholecystolithiasis/surgery ; Cohort Studies ; Diagnosis, Differential ; Emergency Treatment/methods ; Female ; Gallbladder Neoplasms/diagnosis* ; Gallbladder Neoplasms/surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed/methods
Keywords
Acute cholecystitis ; Emergency cholecystectomy ; Fat stranding ; Gallbladder cancer ; Irregular mural thickening
Abstract
PURPOSE: Gallbladder cancer (GBCA) is an uncommon malignancy with vague and non-specific symptoms. GBCA is sometimes diagnosed after emergency cholecystectomy for acute cholecystitis. We investigated the differential diagnosis between GBCA with acute cholecystitis. MATERIALS AND METHODS: Thirteen patients were diagnosed with GBCA after emergency cholecystectomy carried out for acute cholecystitis. A radiologist who was blinded to the final diagnoses retrospectively reviewed the computed tomography (CT) scans of the patients with GBCA and 25 patients with acute cholecystitis. We retrospectively reviewed the medical records of these patients and compared the clinical characteristics and CT findings between patients with GBCA and those with acute cholecystitis. We also investigated the prognostic factors in patients with GBCA who underwent emergency cholecystectomy. RESULTS: Gallbladder (GB) stones were found more often in patients with acute cholecystitis (n = 17, 68%) than in patients with GBCA (n = 7, 53.8%) (p = 0.486). Patients with GBCA showed typical GB masses or focal enhanced wall thickening when compared to diffuse wall thickening in patients with acute cholecystitis. Some GBCA patients showed irregular mural thickening and GB enhancement. Differentiating carcinoma from acute cholecystitis might sometimes not possible, but the latter group of patients had significantly lower C-reactive protein (CRP) levels (p = 0.033) and less regional fat stranding (p = 0.047). Survival was significantly affected by aggressive tumor characteristics (lymphatic invasion [p = 0.025], depth of tumor invasion [p = 0.004]) or R0 resection (p = 0.013) rather than bile spillage (p = 0.112). CONCLUSIONS: Surgeons deciding on emergency cholecystectomy for elderly patients with acute cholecystitis must suspect GBCA in patients with a low CRP level, irregular mural thickening or enhancement of GB without regional fat stranding.
Full Text
https://www.sciencedirect.com/science/article/pii/S1743919117305976
DOI
10.1016/j.ijsu.2017.07.046
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160899
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