MEHMET YILDIRIM, Nazif ERKAN, A. Kemal KAYAPINAR

Safra kesesi kanserinde tanı ve tedavi: Kötü prognoz

Amaç: Safra kesesi kanserleri(SKK), nadir görülen, tanısı güç, kötü prognozlu tümörlerdir. Cerrahi tedavisinde farklı yaklaşımlar bulunmaktadır. Bu nedenle kliniğimizin SKK deneyimi retrospektif olarak değerlendirilmiştir. Hastalar-Yöntem: SSK İzmir Eğitim Hastanesi II. Genel Cerrahi Kliniğinde Ocak 1998-Eylül 2003 tarihleri arasında tedavi edilen SKK olguları, demografik özellikleri, semptomları, tanı yöntemleri, cerrahi tedavileri, morbidite, mortalite ve izlem sonuçları açısından değerlendirildi. Bulgular: Kliniğimizde anılan tarihlerde yapılan 1450 kolesistektomi içinde 9(%0.6) olguda SKK bulundu. Tüm olgular kadın olup, yaş ortalaması 65(55-75/idi. En sık semptom karın ağrısı (%100) ve sarılık (%66) olup, tüm olgulara tanı amaçlı abdominal ultrasonografi yapıldı. 4 (%44) olguda ameliyat öncesi tetkiklerde kolelithiazis tanısına ilaveten, safra kesesinde tümöral kitle bulundu . Bu olguların BT tetkiklerinde iki olguda tümörün karaciğere invaze olduğu saptandı. Beş olgunun tanısı ameliyat piyesinin patolojik incelenmesiyle konuldu. Tüm olgulara laparotomi yapıldı. Ameliyat öncesi SKK tanılı olguların klinik evresi; II (1), III (2), IV (1) idi. Evre II ve III' de birer olguya kolesistektomi, diğer olguya genişle¬tilmiş kolesistektomi yapıldı. Ameliyat sonrası SKK tanısı alan 5 olguda evre; 11(1) ve IV(4) idi. Evre II olguya kolesistektomi, evre IV olgulardan ikisine parsiyel kolesistektomi, birine karaciğer 4 ve 5 segmentektomi + pankreatikoduodenektomi yapılırken, bir olguya sadece biyopsi yapılabildi. Patolojik değerlendirmede tüm olgularda siyah pigmentli taş varlığı yanında, 8 olguda adenokarsinom, 1 olguda da indiferansiye karsinom saptandı. Cerrahi mortalite %11 idi. Izlemde 5 olgu 2-6 (ortalama 4) ayda kaybedildi. 3 olgu 4-22 (ort 9) aydır sağ olarak izlenmektedir. Sonuç: SKK, tanısı çoğunlukla ameliyat sonrası konulan, cerrahi tedaviye rağmen kötü prognozlu komplike bir hastalıktır.

Anahtar Kelimeler:

Geriyedönük çalışma, Neoplazm evrelendirilmesi, Seyir, Laparotomi, Safra yolu cerrahi prosedürleri, Hastalık oranı, Ölüm oranı, Safra kesesi neoplazmları, Demografi, Kolesistektomi

Diagnosis and treatment in gallbladder cancer: Worst prognosis

Purpose: Gallbladder cancer (GBC) is rarely seen, difficult to diagnosis and to have a poor prognosis. There is several strategies on surgical management of GBC. In the present study, GBC cases were analysed retrospectively and literature reviewed. Patients and Methods: From January 1998 to September 2003, patients with a diagnosis of gallbladder cancer analysed with demografic specialities, symptoms methods of diagnosis, surgical treatment, morbidity, mortality and results of observasion period. Results: In our series, nine gallbladder cancer was found in 1450 cholecystectomized patients. All patients were females and age ranged from 55 to 75 years with a median age of 65 years. Abdominal pain (100%) and jaundice (66%) are main symptoms. Preoperative diagnostic imaging consisted routine ultrasound in all cases. The preoperative diagnosis of tumoral mass was correct in four (44%) cases with cholelithiasis. While tumoral invasion of the liver was found in two cases with computed tomography, in other cases gallbladder cancer detected incidentally by histopatologic examinations of gallbladder specimens in patients undergoing cholecystectomy.After the preoperative diagnosis of gallblader cancer stage of disease was II in one patient, III in two and IV in one patient. One of them (stage II and III) underwent cholecyctectomy the remaining patient underwent enlarged cholecysectomy. In patients, accidentally diagnosed after cholecystectomy, stage of disease II and IV was found in one and four patients. Cholecystectomy was performed in Stage II cases. Partial cholecystectomy was performed in two cases with Stage IV disease, exploratomy laparatomy, in one with inoperabl tumor and segmental liver resection of the gallbladder bed with pancreaticoduodenectomy was in the other patient. Conclusion: Because of the rarity of the disease, very few significant clinical trials haven't identified any efficient treatment for long survival. As a result we concluded that the most important prognostic factors are early diagnosis and radical surgery.

Keywords:

Retrospective Studies, Neoplasm Staging, Prognosis, Laparotomy, Biliary Tract Surgical Procedures, Morbidity, Mortality, Gallbladder Neoplasms, Demography, Cholecystectomy,

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