Clinical analysis of 21 cases of gallbladder carcinoma complicated with acute cholecystitis

Objective To investigate the diagnosis, treatment and prognosis of gallbladder carcinoma patients complicated with acute cholecystitis (AC). Methods Clinical data of 21 gallbladder carcinoma patients complicated with AC undergoing surgery in Huadong Hospital Affiliated to Fudan University from January 2009 to January 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 9 female, aged (65±12) years on average. 18 cases were complicated with cholecystolithiasis. According to the severity of gallbladder inflammation, all patients were divided into the mild and moderate groups. The effect of gallbladder inflammation severity and surgical approach upon the survival was evaluated. Survival analysis was conducted by Log-rank test. Results 13 cases were confirmed by intraoperative pathological examination, and the remaining 8 cases were confirmed by postoperative pathological examination. 12 cases underwent open radical resection of gallbladder carcinoma and 9 received laparoscopic cholecystectomy (LC). Postoperative pathological staging indicated that 3 cases were diagnosed with stage 0-Ⅰgallbladder carcinoma, 6 with stage Ⅱ, 11 with stage Ⅲ and 1 case with stage Ⅳ. Patients with stage Tis and T1a gallbladder carcinoma were excluded. In the mild group, the median overall survival was 38 months, significantly better compared with 18 months in the moderate group (χ2=5.615, P<0.05). The median overall survival of patients undergoing open radical resection of gallbladder carcinoma was 25 months, significantly better than 5 months of those undergoing LC patients (χ2=8.412, P<0.05). Conclusions Gallbladder carcinoma complicated with AC is common in elderly patients. The severity of gallbladder inflammation and surgical approach are correlated with clinical prognosis. Intraoperative frozen pathological examination should be positively adopted. Open radical cholecystectomy is recommended for non-Tis and T1a stage patients. Key words: Gallbladder neoplasms; Cholecystitis, acute; Surgical procedures, operative