A curative surgical approach to gallbladder carcinoma in its early stages.

The study is based on 20 personal cases of gallbladder cancer and 254 similar cases from five surgical departments. The contradictory results obtained by surgery are explained by the special structure of the gallbladder wall and the bipolar connections with the liver and lymphatic ducts. Personal experience and literature reports evidence the possibility of cure for various stages: macroscopic lesions, while qualified as early stages are actually already advanced and necessitate extended liver resection with considerable lymph node dissections; the so-called early stage, detectable solely by histology, is harmful since the entire thickness of the mucosa is involved and always requires enlarged cholecystectomy to include the liver and lymph nodes. In this case good survival rates are possible; in situ pre-epithelial lesions diagnosed by cytology, are amenable to cure by simple cholecystectomy. Prevention rests on a wide range of indications for cholecystectomy (lithiasis, female sex, age over 50 years).