Carcinoma of the gallbladder and cholecystostomy

W. N. Castle, H. J. Wanebo and R. E. Fechner

Seven cases of carcinoma of the gallbladder after cholecystostomy were seen at the University of Virginia Medical Center, Charlottesville, between 1926 and 1979. These cases represented 6.7% of all cases of carcinoma of the gallbladder treated at that institution during that period. The interval between cholecystostomy and diagnosis of carcinoma ranged from three months to 40 years. Five patients had "gallbladder" symptoms intermittently during the interval, and two patients did not. One of the patients had a confirmed calcified or porcelain gallbladder five years before the development of carcinoma. At operation, none was found to have localized disease, and most had extensive metastatic disease. There were no survivors. Primary carcinoma of the gallbladder is an aggressive disease and difficult to diagnose. Few specific characteristics are available to the clinician and surgeon to detect this disease in its early stages. Patients who undergo cholecystostomy or have undergone cholecystostomy, with or without symptoms, should have elective cholecystectomy if they are acceptable operative risks. Such a policy would prevent a small, but substantial, number of cases of carcinoma of the gallbladder.