Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Jan 2002
Comparative StudyShould suspected early gallbladder cancer be treated laparoscopically?
Early gallbladder cancer (EGC), defined as T1 and T2 disease, is frequently curable when completely excised without bile spillage. The objective of the present study was to determine what effect initial laparoscopic cholecystectomy has on outcome in patients with EGC. Of 89 patients referred to our institution with gallbladder cancer over an 11-year period, 26 had undergone initial laparoscopic cholecystectomy. ⋯ One-year Kaplan-Meier survival (T1 = 89%, T2 = 71%) and 3-year Kaplan-Meier survival (T1 = 47%, T2 = 40%) of these patients is worse than prior reports for open cholecystectomy. An initial laparoscopic cholecystectomy with its potential for bile spillage can convert potentially curable EGC to incurable disease. Patients with preoperative findings suspicious for gallbladder cancer should undergo open exploration with intent to perform a radical cancer operation as a primary procedure if the diagnosis is confirmed intraoperatively.
-
J. Gastrointest. Surg. · Jan 2002
Comparative StudyLong-term survival after esophagectomy for Barrett's adenocarcinoma in endoscopically surveyed and nonsurveyed patients.
There is growing controversy over the cost-effectiveness of surveillance endoscopy for patients with Barrett's esophagus. A retrospective review was performed of 80 patients who underwent resection for Barrett's adenocarcinoma to assess the influence of endoscopic surveillance on long-term survival. Twelve patients initially were diagnosed with benign Barrett's esophagus and were followed with endoscopic surveillance. ⋯ Median survival for patients in the surveillance group was 107 months compared to 12 months for those in the no surveillance group (P < 0.001). Stratifying for stage, surveillance (hazard ratio = 3.05; confidence interval = 1.09 to 8.57; P = 0.034) was the only predictor of survival. Surveillance endoscopy permits early diagnosis of adenocarcinoma in patients with Barrett's esophagus and contributes substantially to long-term survival.