Carcinoma of the gallbladder: a risk associated with gallbladder-preserving treatments for cholelithiasis.

Abstract

Five cases of carcinoma of the gallbladder associated with nonsurgical treatment of cholelithiasis are presented in view of the recent interest in gallbladder-preserving procedures. Three patients developed gallbladder cancer that was diagnosed 4, 11, and 72 years, respectively, after cholecystostomy. One other patient had gallbladder carcinoma diagnosed 7 months after extracorporeal shock wave lithotripsy for common bile duct stones. The tumor was probably present but not identified at the time of lithotripsy. The last patient had undiagnosed gallbladder malignancy at the time of cholecystostomy for treatment of acute calculous cholecystitis. Gallbladder carcinoma has been reported in 1% of patients undergoing cholecystectomy, and the risk of carcinoma developing in patients with asymptomatic cholelithiasis has been estimated at less than 1%. These figures should not diminish the role of gallbladder-preserving treatments in elderly and selected high-risk patients for whom cholecystectomy may be hazardous. However, such patients must undergo a thorough imaging assessment both before and after treatment to ensure that a gallbladder carcinoma is not overlooked.

Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography

“…On T2‐weighted image, all the tumour masses were heterogeneously hyperintense. The association of gallstones with gall bladder carcinoma is well known 15 . Gallstones were seen in 47% of our cases.…”

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

“…Nevertheless, although the frequency of gallstone recurrence is high, PCCL is still useful in elderly patients who may not be able to tolerate cholecystectomy, because most patients with recurrent stones were asymptomatic (14). The other concern regarding the preservation of the gallbladder in PCCL is of subsequent gallbladder cancer development in patients with acute calculous cholecystitis (17). However, the short life expectancy in debilitated high surgical risk elderly patients reduces concerns of recurrent stones or cancer development.…”

Contribution of silent gallstones in gallbladder cancer

“…The results of medical dissolution therapy, contact dissolution with methyl tert-butyl ether or biliary lithotripsy have been disappointing and not cost-effective in the long run and such treatments may be attempted in elderly and selected high-risk patients for whom cholecystectomy may be hazardous [6,28,29]. However, such patients are at risk of developing gallbladder cancer and hence must be kept under strict follow up to ensure that diagnosis is not missed [30].…”