Surgery for carcinoma of the gallbladder

BACKGROUND/AIMS

Carcinoma of the gallbladder is one of the gastrointestinal malignancies with an extraordinarily poor prognosis. The 5-year survival rate amounts to less than 5 per cent in most series. Our aim was to analyze the experience of a single center with surgery for gallbladder carcinoma with special reference to liver wedge resection.

MATERIALS AND METHODS

A retrospective analysis examined all patients of the Clinic of Surgery of the Humboldt University Medical School (Charité) with diagnosed gallbladder carcinoma operated on between January 1981 and August 1993. The analysis was based on patient documentation. Cumulative survival rates were calculated according to the method of Kaplan/Meier. Statistical significances were calculated using logrank and Wilcoxon's tests.

RESULTS

Eighty one patients (61 female, 20 male) were included in the study. The preoperative diagnoses were confirmed in 33 patients (40.7%). The stage distribution according to the TNM-system revealed 6, 10, 12, and 53 patients at the stages I-IV, respectively. The curative resection rate was 22.2%. Stage-dependent surgical procedures resulted in cumulative survival rates of 33.3% for stages I and II, 8.3% for stage III and 1.9% for stage IV. The overall prognosis was significantly determined by metastatic spread to the lymph nodes.

CONCLUSIONS

Diagnostic efforts should focus on detecting the low stages I and II of gallbladder carcinoma. Our results suggest that aggressive surgical management with second intervention and wedge resection or more extended liver resection is the method of choice for stage T1b or more advanced stages of gallbladder carcinoma.

Absence of the Asian-specific region V mitochondrial marker in Native Beringians

The Asian-specific 9-bp deletion between the genes for mitochondrial cytochrome oxidase II and lysine transfer RNA has been used to trace aboriginal human movements out of Southeast Asia and into portions of the South Pacific. Although it has been used to estimate the number of independent lineages that occur in the New World, it has not been studied in native peoples of the Beringian region. Thus, we have used PCR to amplify and compare the lengths of DNA segments surrounding this deletion in native peoples of Beringia and the adjacent regions, as well as natives of the Altai Mountains of Southwestern Siberia. Of the 176 individuals analyzed here, the deletion was found in only 3 of 25 individuals from the Ust-Kan region of the Altai Mountains. We comment on the distribution of this marker and on potential relationships between Beringians and other Native American groups in which this marker has been surveyed. One Chukchi possessed three copies of the 9-bp sequence, which suggests (1) that the number of copies of this sequence in humans may be more variable than had been believed and (2) that a mechanism of replication based on tandem duplication may be a potential explanation for the origin of this length mutation in humans.