SAFRA KESESİ KANSERLERİNİN TANI VE TEDAVİ SORUNLARININ RETROSPEKTİF OLARAK DEĞERLENDİRİLMESİ
Giriş: Safra kesesi kanserleri nadir görülmekte olup, klinik olarak safra kesesinin benign hastalıklarıyla benzer semptomlar vermesi nedeniyle zor tanı konulan, tanı konulduğunda ise genelde ileri evrede saptanan kötü prognozlu tümörlerdir. Çalışmamızda safra kesesi kanserlerinde tanı ve tedavide karşılaşılabilecek sorunlar irdelendi. Gereç ve Yöntem: İzmir Bozyaka Eğitim ve Araştırma Hastanesi Genel Cerrahi kliniklerinde Şubat 1995-Haziran 2011 tarihleri arasında tedavi edilen safra kesesi kanseri olgularının retrospektif olarak değerlendirildi. Bulgular: 12920 kolesistektomi içinde 80 (%0.6) olguda safra kesesi kanseri bulundu. Olguların 58 (%72)’i kadındı. En sık semptomlar karın ağrısı (%97), sarılık(%31), bulantı-kusma(%27) idi. 80 SKK olgusundan 43 (%53.7) tanesine ameliyat öncesi tanı konulurken 18 (%22.5)i ameliyatta tanı almıştır. 19 (%23.7) hastaya ise kolesistektomi yapıldıktan sonra histopatolojik inceleme sonucunda tanı konulmuştur. Tüm olgulara laparotomi yapılmış olup Evre I‘de 7 (%8.75) olgu, Evre II’de 16 (%20) olgu, Evre III’de 30 (%37.5) olgu, Evre IV’de 27 (%33.7) olgu saptandı. Cerrahi tedavi olarak hastalara: kolesistektomi, kolesistektomi ve değişik tipte KC rezeksiyonları, kolesitektomi ve biliyer drenaj ameliyatları, parsiyel kolesistektomi veya insizyonel biyopsi ameliyatlarından biri yapıldı. Histopatolojik olarak en sık karşılaşılan tip 69 (%86.2) olgu ile adenokarsinomdu. 13 olgu ortalama 16.8 (1-46) ayda kaybedildi. Sonuç:Safra kesesi kanseri benzer semptomlar nedeniyle benign safra kesesi hastalıklarıyla ayırıcı tanısı yapılması gereken, gelişmekte olan tanı ve agresif tedaviye rağmen halen kısa survi ile seyreden kötü prognozlu komplike bir hastalıktır.
RETROSPECTIVE EVALUATION OF THE DIAGNOSIS AND TREATMENT OF THE GALL BLADDER CANCER
Introduction: Gall bladder cancer is a rare disease with poor prognosis and usually diagnosed at the late stages because sings and smptoms mimic other benign disorders of gall bladder. Incidence rises in elderly and other accompanying gall bladder pathologies make diagnosis confusions. Due to rareness of the disease there is no sufficient data in the literature. We examine the probable difficulties during the diagnosis and treatment of the disease. Material and Methods: Gall bladder cancer patients admitted to Izmir Bozyaka Training and Education Hospital between February 1995 and June 2011 were retrospectively examined based on demographic features, symptoms, coexistant diseases, diagnotic methods, preop diagnosis, surgical interventions, disease stages, histopathologic diagnosis, morbidity, mortality, follow-up and survival results. Results: Among 12 920 cholecystectomies in between the time interval mentioned above, 80 (0,6%9 gall bladder cancer had been diagnosed. There were 58(72%) female and 22(28%) male with overall mean age of 65(24-99). Mostly abounded symptoms in decreasing order were abdominal pain (97%), jaundice (31%), nausea and vomitting (27%). All patients were undergone routine abdominal ultrasonographic evaluation and those revealed tumoral lesion at the gall bladder localisation were further examined with abdominal CT and/or MR/MRCP. Diagnosis of gall bladder cancer could be done preoperatively in 43(53,7%) cases and 8(22,5%) were diagnosed intraoperatively. Remaining 19 (23,7%) cases were diagnosed histopathologically after regular cholecystectomy. All the cases with gall bladder cancer were undergone laparotomy and 7(8,7%) cases with stage I; 16(20%) cases with stage II; 30(37,5%) cases with stageIII; 27(33,7%) with stage IV. Surgical interventions were cholecystectomy; cholecystectomy with different kinds of partial liver resections; cholecystectomy and biliary drainage procedures; partial cholecsytectomy or incisional biopsy. Adenocarcinoma was dominating histopathological diagnosis with 69(86,2%) cases however 5(6,2%) adenosquamous cancer, 5(6,2%) indiffent carconoma, 1 (1,2%) squamous carcinoma cases were diagnosed so for. The number of patients reached on the phone after discharge were 22. Of them 13 were dead after average of 16,8(1-46) months and 9 patients were still alive for average of 48(4-132) months. Conclusion: Gall bladder cancer differantial diagnosis should be kept in mind due to presenting similar signs and symptoms of benign pathologies. Despite of the developments in diagnosis and agressive treatment modalities, gall bladder cancer is still a complex disorder with short survival and poor prognosis.
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- İzmir’in Kanser Verileri. KİDEM. Web sitesi:“www.ato.org.tr/konuk/kidem/Tdoc3.htm
- Donohue JH, Stewart AK, Menck HR. The National Cancer Data Base Report on carcinoma of the gallbladder, 1989-1995. Cancer 1998; 83(12):2618-28.
- Nagakawa T, Kayahua M, Ikeda S, Futahawa S, Kahuta A, Kawarada H et al. Biliary Tract Cancer in Japan. J Hepatobiliary Pancreas Surg 2002;9(5):569-75.
- Foster J. Carcinoma of the gallbladder, In: Way LW, Pellegrini CA, editors. Surgery of the gallbladder and bile tract. Philadelphia: W.B. Saunders Company; 1987:p471-85.
- Gençosmanoğlu R, Şad O, Kır G, İnceoğlu R. Safra kesesi kanseri: iki olgu. PTT Hastanesi Tıp Dergisi 2000; 22(3):164-70.
- Way LW. Biliary Tract. In: Way LW, editors. Current surgical diagnosis and treatment. 8. Edition, East Norwalk:Appleton and Lange; 1988: p508–12.
- Küçük C, Erdoğan G, Güler İ, Avşaroğulları L, İkizceli İ. Safra kesesi karsinomları. Çağdaş Cerrahi Dergisi 2002;16:78–81.
- Adam A. Biliary radiology. Current opinion in Gastroenterology 1971; 7(5):777-83.
- Lotze MT, Flickinger JC, Carr BI. Hepatobiliary Neoplasms. In: Devita V, Hellman S, Rosenberg S, editors. Cancer: Principles and Practice of Oncology, 4th ed. Philadelphia :JB Lippincott Co; 1993: p 883–914.
- Cubertafund P, Gainant A, Cucidal G. Surgical treatment of 724 carcinoma of the gallbladder: long-term results. Ann Surg 1994;219(3):275-80.
- Wood R, Fraser LA, Brewster DH, Garden OJ. Epidemiology of gallbladder cancer and trends in cholecystectomy rates in Scotland 1968–1998. Eur J Cancer 2003;39(14):2080–6.
- Lin HT, Liu GJ, Wu D, Lou JY. Metastasis of primary gallbladder carcinoma in lymph node and liver. World J Gastroenterol 2005;11(5):748-51.
- Bach AM, Loring LA, Hanu LE, Illescas FF, Fong Y, Blumgart LH. Gallbladder cancer; Can ultrosonography evaluate extent of disease ?. J Ultrasound Med 1998;17(5):3003-9.
- Stephan AE, Berger DL. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery 2001; 129(6): 699-703.
- Egawa N, Tu Y,Kamisawa T, Amemiya K, Tsurata K, Okamoto A, Funata N. A comparative clinical study of gallbladder tubular adenocarcinoma according to the grade of differantiation. J Gastroenterol 2004;39(10):975-80.
- oyonaga T, Chijiiwa K, Nakano K, Noshiro H, Sada M, Terasaka R. Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg 2003; 27(3):266-71.
- Yüzer Y, Akgün E, Kılıç M, Özütemiz Ö, Yılmaz F. İleri evre safra kesesi kanserlerinde karaciger rezeksiyonuyla birlikte pankreatikoduodenektomi. Klinik Deneysel Cerrahi 1999; 7(1): 27-31.
- Tasakı K, Yamamoto Y, Watanabe K, Asano T, Honda I,Watanabe S, et al. Successful treatment of lymph node metastases recurring from gallbladder cancer. J. Hepatobiliary Pancreat Surg 2003;10(1):113-7.
- North SH, Pade MS, Hong C, Rıvera DE. Prognostic factors for adenocarcinoma gallbladder: an analysis of 162 cases. Am Surg 1998; 64(5):437-40.
- Zheng SS, Liang TB, Qin YS, Zhang M, Wang WL, Shen Y et al. The long term result of manegement in 98 cases of gallbladder carcinomas. Zhonghua Wai Ke Za Zhi 2004;42(9):517- 9.
- Wakabayashi H, Ishiumura K, Hashimato N, Otani T, Kondo A, Maeta H. Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer . Eur J Surg Oncol 2004;30(8):842-6.
- Nagakira S, Shirai Y, Yokoyama N, Hatakayama K. Clinical significance of lymph node micrometastases in gallbladder carcinoma. Surgery 2001;129(6):704-13.
- Yamamato M, Miura K, Yoshioka M, Matsumato M. Disease free survival for 9 years after liver resction for stage 4 gallbladder cancer: report of a case. Surg Today 1995; 25(8):750-3.
- Levi F, Lucchini F, Negri E, La Vecchia C. The recent decline in gallbladder cancer mortality in Europe. European Journal of Cancer Prevention 2003; 12(4):265-7.
- Pearlstone DB, Curley SA, Ferg BW. The management of gallbladder cancer: before during and after laparoscopic cholecystectomy. Semin Laparasc Surg 1998; 5(2):121-8.
- ISSN: 1305-5151
- Başlangıç: 1995
- Yayıncı: İzmir Bozyaka Eğitim ve Araştırma Hastanesi
Sayıdaki Diğer Makaleler
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