Incidentally discovered gallbladder cancer: Role of cryotherapy

Background and Objectives: Carcinoma of the gallbladder is the most common malignancy of the biliary tree. There is no standard surgical approach to the treatment of gallbladder cancer. Extended cholecystectomy with partial or complete hepatic lobectomy has resulted in high morbidity and poor long-term survival. This report describes cryotherapy of the gallbladder fossa as an alternative to liver resection in the treatment of gallbladder cancer. Methods: A group of patients underwent cryotherapy to the gallbladder fossa for local control of gallbladder cancer. Portal lymph node dissection was performed at the same time and patients with positive lymph nodes received post-operative chemotherapy and radiation; negative node patients were observed. Results: Seven patients underwent surgery. Gallbladder cancer had been incidentally found in all patients. Median hospital stay was 4 days. Five patients had positive nodes. Complications included biliary stricture, pleural effusion, congestive heart failure exacerbation, and pulmonary embolus. Mean disease-free survival for patients with T2 tumors was 11.7 months. Mean disease-free survival for patients with T3 tumors was 16.3 months. Mean disease-free survival for lymph node positive patients was 14.8 months compared to 13 months for node negative patients. No local recurrences have been detected in the gallbladder fossa. Conclusions: This study suggests cryotherapy to the gallbladder fossa done concomitantly with portal lymph node dissection may represent a safe and effective alternative to hepatic resection in the treatment of gallbladder cancer. (C) 2004 Wiley-Liss, Inc.