PubMed · 10977124
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D J Gouma. 2000. When are gallbladder polyps malignant?. https://doi.org/10.1155/2000%2F34201
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Polyps in the gall bladder are detected in 4-5% of the population and most of them are benign. However, they can be premalignant and the prognosis for gall bladder carcinoma is still poor. As with other cancers, treatment at an early stage is therefore, considered essential to improve the prognosis. Because of the very low morbidity after laparoscopic cholecystectomy we recommend laparoscopic cholecystectomy when a polyp in the gall bladder is detected by ultrasonography. A wait and see attitude with repeated ultrasonography twice a year may be chosen, if there are contra-indications to laparoscopic cholecystectomy. If the lesion increases in size, cholecystectomy should be performed.
Hepatopacreatoduodenectomy (HPD) was initially performed to resect highly advanced gallbladder carcinoma with direct invasion of the liver and head of the pancreas. High operative morbidity and mortality rates and early recurrence were major problems of this procedure. However, the operative outcome gradually improved with progress in surgical procedures and perioperative management. Recently, HPD has been indicated not only for direct invasion of the liver and pancreas but also for intensive dissection of peripancreatic lymph nodes and resection of occult liver metastasis to subsegments IV and V. Evaluation of all cases in which HPD was performed in our institute suggests that advanced gallbladder carcinoma with lymph node metastasis and without high-grade infiltration of the hepatoduodenal ligament (binf) is the most suitable indication for HPD.
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