T9P chi GAN MAT VIETNAM so 21-2012 45
Ung thu* tiii mat tai Benh vien Binh Dan
Cancer of the gallbladder at Binh Dan hospital
VAN T A N , DU'ONG V A N H A I , N G U Y E N C A O CU'ONG, BOi M A N I I C O N , H O A N G D A N H T A N
Abstrac
Background: Cancer of the gallbladder (GB) have bad prognosis. In the occidental countries, the rate of survival 5 years isfivm 5 to 38%. Cancer of the GB is the 5"' digestive cancer, usually met on female over than 65yo.
Cancer of the GB relate to chronic inflamma- tion. Cholecystis with stones that are the main cause, occupy from 75 to 90% of cases. In USA. men who have stone in the biliary system and chronic inflammation, have cancer of the GB 7'* time more than men who have no stone and inflammation of biliary system. Objective:
We study the clinical manifestations and the surgical result of the GB cancer.
Patients and Method: It is apoststudy of the GB cancer from July 2006 to December 2009.
Result: 80 cases of GB cancer among 7456 cases ofLC. In the 80 cases, male 40, female 40. and middle age 55. 10 cases have gall stones, the ratio is 12,5.
- Group 1: 33 cases, patients have subcostal pain with fever, dyspepsy mimic as acute or chronic cholecystitis with stones in the gall bladder The ultrasound not found abnomality, but the pathology found cancer in the wall.
Group 2: they have exquise pain of subcostal or RUQ pain, with light jaudice. At examina- tion, we found a subcostal mass. The ultra- sound or CT found a thick or irregularity of the gall bladder wall or a mass develop intra lumen of the gall bladder
- 33 cases have LC and 47 cases, opened cholecystectomy, at the same time, we operate in LC 300 cases of polyp ofGB with 5 cases.
The cases that the LC are done have tumor confine in the GB, and no lymph nodes. The cases that cancer develop out of the GB wall
are extended removal of the GB, in opened cholecystectomy: 4. cholecystectomy - CBD drainage; 29, cholecystectomy - hepatectomy:
6, cholecystectomy - CBD removal, with bil- iary anastomosis; 2, cholecystectomy - CBD removal, biliari-enterotomy anastomosis; 3, cholecystectomy - gastrointestinal anastomo- sis: 3. removal of lymph nodes.
There are 42 cases stayed in hospital over 10 days. 1 case died in hospital for 35"' days, 72 yo, due toflstula, cirrhosis and debility.
In the follow-up during 2 years, the 33 cases Tl, 85% is still alive. The cases of extended cholecystectomy (47 cases), 45 % is still alive, but there are 18 cases came back to hospital because of stenosis of bile tract or small bowel, they must be reoperated. Almost cases have chemotherapy with 5 FU and cisplatinum..
Discussion: Cancer of the GB has the rate over 1% (80 cases/7456 cases removal of the GB). That rate is the same in comparison with the other countries as in USA, that is l%for the cases of elective cholecystectomy. The diagnosis is difficult in early case. On ultra- sound or on CTscan, the cystic wall is local- ized thick and irregularity, the biopsy make the diagnosis. When the tumor advanced, it is papable in RUQ. It invases the liver, obstructs the CBD and other organs.
The operative technique base on T. When the tumor is Tl, no nodes, cholecystectomy is radical cure, In our hospital, we performed the LC. If the tumors is T2, we turn to open and extended cholecytectomy, removal of lymph nodes and bilioenteric anastomosis.
Conclusion: Cancer of the GB is a severe disease. As, clinical manifestations, the syn-
BV Binh Dan 371 DBP Q3 TP Hd Chi Minh Phan bien khoa hgc: PGS Pham Gia Khanh
4 6 Tap chi GAN MAT VI$T NAM s6 21 -2012
drom is mimic a chronic or acute cholecystitis, except the advanced case that the tumor is in the subcostal area.
We perform the LCfor the early cases (TI).
In advanced cases. LC causes seeding the Tdm tk
Ung thu tiii mgt cd tien lugng xiu, d phuang tay, ti le song 5 ndm Id tii 5 din 38%.
Ung thu tiii mgt diing hdng thii 5 trong ung thu tieu hoa, thudng gdp d nu, tren 65 tu6i. Ung thu tiii mat cd lidn he viem kinh nien, md sdi mat Id nguyen nhan chinh, chiem 75 den 90%
trudng hgp. d My, ngudi bj sdi m§t vd vidm kinh nien bi ung thu 7 lin hom ngudi khdng bj sdi mat vd khdng viem. M^ic tiiu: Nghien ciiu ung thu tiii mgt vc 1dm sdng vd kit qud dieu trj.
Dot tugntg vd Phuffngphdp: Ld hoi ciiu nhiing trudng hgp ung thu tiii mat tu thdng 7 nam 2006 din hit thang 12 nam 2009.
80 trudng hop (TH) ung thu tiii mat trong sd 7456 TH cat tui mat viem dugc tim thiy.
Trong sd 80 TH cd nam 40, nir 40, tudi trung binh 55. Cd 10 TH cd sdi tiii mdt, chilm ti le 12,5. Kit qud: Ve lam sang.- Nhdm thii nhit:
Benh nhan dau ha sudn phdi, thinh thodng cd sdt. Cd khi viem tiii mat cip hay kinh nien, thdnh tiii mat ddy. Sau md, tren hinh dnh md budu mdi thay u, nhdm nay cd 33 TH. Nhdm thii hai: u sd dugc d ha sudn phdi, xam lin gan, chen ep dudng mat gay vdng da tdc mat, nhdm nay cd 47 TH. Tren sieu am hay CT, thiy thdnh tiii mdt day mgt chd, thdnh tiii mat khdng deu hay u Idn bung ra trong long tiii mgt vd xdm lan gan, dudng mat nhdm thii hai.
Viphdu thu^t: Cd 33 TH md ngi soi vd 47 TH mo md, trong thdi gian dd, cd 300 TH polip tiii mat, hau het dugc md ngi soi, chi cd 5 TH md md. Nhiing TH md ndi soi gdm cd u khu tru trong tiii mat, khdng thiy hgch. Nhung TH md md gdm cd u da an lan ra khdi thanh tiii mat nen cat tiii mat md rdng, nhu cit tiii mat l . D a t v a n d e
Ung thu tiii mat Id ung thu ngng, thudng xiy din vdi ngudi cao tudi. Tni trudng hgp tim thay trong cdt tui mgt ngi soi vi sdi gay viem thudng sdm, hiu hit dugc phdt hi?n d giai
cancer cell. So when we found tumor that is T2, the opened cholecystectomy is mandatory, removal nodes, removal the extended viscera and anastomosis. The prognosis is bad in these cases.
md 4 TH, cat tiii m^t, md OMC DL 29 TH, cdt tiii m^t, cit gan 6 TH, cdt tiii m^t, cdt ong mgt chii, n6i ong m§t chii, din luu Kehr, 2 TH, cit liii m^t, cit Ing m^t chu-n6i m$t rudt 3 TH, cit tiii m§t- noi vj trdng 3 TH,..., nao hach.
42 TH nim vien tren 10 ngdy. 1 TH tii vong, nim vi0n 35 ngdy do dd mat-rudt din den suy ki^t.
Trong theo doi nhiing TH Tl, cd 31 TH, theo ddi trung blnh 2 ndm, 85% TH cdn song;
nhixng TH phlu thugt md r§ng, theo ddi dugc 21 TH, 45 % cdn song. Cd 18 TH md Igi vi nghet mgt hay nghet rugt. Hod tri vdi 5FU va cisplatin nhung khong the lugng gia ket qua.
Bdn lugn: Ung thu tui mat chiem ti le hon 1% (80 ca/7456 ca cit bd tui mat). Ti 1? nay gin bdng, so vdi nude ngodi, nhu d My ti le la 1 % vdi nhung TH cat tui mat kl hogch. Tat ca u trong thanh tiii mgt deu dugc mo ngi soi, khi thii nghiem md budu mdi biet Id ung thu gdm 33 trudng hgp. 47 trudng hgp cdn Igi dugc md md hay chuyen md md.
Phlu thugt dua vdo T. Khi khoi u con d Tl, khdng cd hgch di can thi cdt tiii mat Id du, d BV chiing tdi, thudng cit qua ngi soi. Ndu u la T2 thi phdi cat tui mgt md rdng nen mo mdhay chuyin md md, ngo hgch, noi mat mgt.
Ket lu^n: Ung thu tui mgt Id ung thu ngng, can de phdng khi cat tui mgt noi soi, ddc biet la nhiing TH da bi biln chiing nhu viem tiii mat cip, apxe tiii mgt, tiii mgt hogi hi, VPM mat, cit tiii mgt md khdng dl y 1dm vung rai tl bao ung thu. Khi budu d T2, nen md md, cit tiii mgt ngo hgch tdn gdc, cat cac bg phan dn Ian.
Tien lugng khdi u T3 thudng xiu.
dogn tre, cd tien lugng xiu. 6 phuong tay, ung thu tiii mlit, ti le sdng 5 nam Id tCr 5 din 38%
[3,9,13,17,19]. Bit hgnh thay, cd nhilu tnidng hgp khdng cdt bd dugc khi tim thiy. Mdi day,
n p chi GAN MAT VIET NAM so 21-2012 47
nhd phau thugt tien bg, nhiing trudng hgp ung thu cdn khu tru, tien lugng ml khd [4,11,12,15].
Ci My, ung thu tiii mat diing hdng thii 5 trong ung thu tieu hod, thudng ggp d nii, trdn 65 tudi. Ung thu tui mat cd lien he ddn viem kinh nien, md sdi mat Id nguyen nhan chinh, chilm 75 din 90% trudng hgp. Ngudi bj sdi mat va viem kinh nien bi ung thu 7 lin hon ngudi khdng bi sdi mat vd khdng viem [3].
2. Doi tugng v^ phu(mg phip
La hdi c ^ nhihig ca ung thu tui m^t tii thang 7 nam 2006 den het thdng 12 nam 2009.
Trong suot thdi gian hon 3 nam rudi, chiing tdi tim dugc 80 ca ung thu tui mdt, 10 trudng 3. Ket qua nghien cihi
Ngodi ra, nhung trudng hgp tiii mat da polip, tui mgt sdnh hod, tiii mgt c6 nang hay xa hoa dudng mat cung se bien thdnh ung thu. Ung thu tiii mat cdn Id tii polyps [1].
Khi djnh b?nh, 25% cdn khu tni d thdnh tiii mat, 35% da di can hgch hay xdm lin cdc bg phdn lan can vd 40% da di can xa [9,17].
Myc tiiu: Chung toi nghien cuu ve dac diem lam sdng, can lam sdng vd kit qud dieu trf ung thu- tiii mat tgi b?nh vi^n Binh Ddn.
hgp c6 sdi trong tiii mat, ti le la 12,5 %, 1 trudng hgp sdi trong gan trdi vd phdi. Trong liic dd cd 300 trudng hgp polip tiii mat, c6 48 ca cd sdi, ti le 16%, md md Id 5 trudng hgp :
dng 1. Tuoi vd giai:
Tu6i
< 3 9 4 0 - 5 9 6 0 - 7 9
> 7 9
Nam 10 17 11 2
Nil 2 21 12 5
T6ng 12 38 23 7
Tong so 40 80
80 ca ung thir hii mat trong s6 7456 TH cit tiii mat viem, chiSm ti le 1%. Trong s6 80 TH co nam 40, nil 40, tu6i trung binh 55. Nam m6i tre nhieu. Nil tuoi gia nhieu..
- Bdng 2. Lam sdng Dau hieu
Phat hien tinh co khi oil TM/NS Giam can
Vang da Vang niem mac Dau HSP Khfii u HSP Kh6i u thuong vi
Soca 32 42 22 62 43 04 Dua vao SA v4 CTscan;
Khong thdy bit thucmg, trir s6i 30%
Khdi bit thudng or giuong tiii m jt, soi 40%
Thanh tui m$t diy bit thudng 30 %
Khong thiy bit thucmg, hir soi 10%
Thanh toi mat khong d6u 45%
Khdi thiy toi mat, xam lin cac bo phan lan can 22%
Cac hinh anh hen cho thiy toi mat hi ung thu khong cit bo dugc.
- Bdng 3. Dinh benh : SA8bTH
CTIOTH
n 2 31 6 5 3 1 47
Bi^n chiing 1 3 1 1 0 0 6(12,76%)
Tu vong 0 0 0 1 0 0 1(1,3) 48 Tap chi GAN MAT VlSTNAMs6 21-2012
- Bdng 4. Ket qud phdu thugl:
PhSuthu^t n Bidn chiing Til?%
M 6 N S 33 0 0 Uhmi, 47 6 12,76 Tong so 80 6 12.76 - Phiu thu?t npi soi: Tit c4 c6 33 TH, khong bj bidn chiing vi, to vong.
Do la nhirng TH c6 u khu tni trong toi m?t, kh6ng thiy h?ch. Trong thdi gian dd, cd 300 TH polip toi mat, hau het dugc mo ndi soi, chi cd 5 TH m6 md, cd 2 trudng hpip ung thu.
- Bdng 5. Phdu thuQt md ma:
Phiu thuat
cat bin phan toi m}t - din Ittu (DL) cat toi iTiat + n?o hjch - md OMC-DL cit toi mjl + cit gan, njio hjch-DL OMC Cil TM + nao hjich, cit OMC-noi mit rudt Cit toi mat + ndi mjil rupt-noi vi tring cit tiii mat + cit OMC-DL ong gan Tong sd
Nhirng TH md md gdm cd u da an lan ra khdi thinh tlii mat nen cat toi mat md rpng, nhu cat ban phin toi mat 2, cit toi mat+ nao hach-md OMC DL 31 TH, cit toi mat+cit gan, nao hach, DL OMC 6, cit toi mat+nao hach, cit OMC, mat-rupt 5, cit toi mat- noi vi uang 3, cat toi m?t, c5t OMC, DL dng gan. Bien chiing la 6 (12,76%).
3 tuin sau, 40 TH deu cd didu trj bd tiic bing hoi chat 5 FU va cisplatin, chua cd TH nao dieu tri bang tia xa, hieu qui khdng xic dinh dugc.
- Thdi gian nim vien: 42 TH tren 10 ngay. Thdi gian nim vicn trung binh md NS li 4 ngay, mo md la 8 ngay. Thdi gian nim vien dai nhat ctia md ngi soi li 12 ngiy, cdn md md la 35 ngiy.
1 TH to vong, nim vien 35 ngay do dd mat-rupt dan den suy kiet. Ca niy li nam 72 mdi, bi ung thu toi mat an lan OMC. BS phiu thuat md md, cat tui mat, cat OMC - ndi mit -nipt, hi xi ngiy thir 5 sau mo. md lai, bj dd mat tiep. Tii vong d ngiy thir 35 sau md do dd rugt, xg gan vi suy ki?t (1,25%).
- Md budu hau het: Adenocarcinoma - Bdng 6. Giai dogn benh [3]:
Giai doan 0 I II IIIA IIIB IVA IVB
Giai do?n TNM Tis (NOMO) TINOMO T2N0M0 T3N0M0 T1-3N1M0 T4N0-1M0 BatkyTbitkyNMl
So 2 10 12 14 15 10 17
Tdng sd 80 -Theo doi:
Nhiing TH T1, md NS, chiing tdi c6 31 TH, theo doi trung dugc 2 nam, 85% (26) TH cdn s6n|, 54% {14) TH tai phat, 1 TH nghet mieng noi khdng phii tii phit. Tit ci ddu dugc md lai: 6 TH noi
Tgp chi GAN MAT VIETNAM s6 21-2012 49 lai mat rugt, 2 TH noi vi trdng, 6 TH md dng
gan ra da. Khdng cd TH ndo di can do ngi soi.
Nhung TH phlu thuat md rOng, theo doi dugc 21 TH trong 2 nam, 45 % (9) cdn sdng.
Tit ca ddu tdi phat. Cd 18 TH ml Igi vi nghet mat hay nghet rugt trong dd cd 10 TH md thdm 4. Bfin luan
Ung thu tui mgt chiem ti 1? hon 1% (80 TH/7456 ca cat bd tiii mat). Ti le ndy gin bdng so vdi nude ngodi nhu d My ti I? Id I % vdi nhung TH cit tui m|it ke hogch [3]. Ti 1? ung thu tui mgt cao d An Do vd Hdn Quoc. Tuoi trung binh d My la 65, d Vigt Nam Id 55. Ci My nii nhieu hon nam 2 din 3 lan. Ung thu tiii mgt la ung thu hiem, diing hang thii 5 trong img thu tieu hod. Tudi trung binh d Viet Nam trd hon d My, d My tudi trung binh Id 65. 0 My 40%
trieu chiing gidng nhu viem tui mat kinh nien, d mgt sd khdc, trieu chiing gidng nhu viem tiii mat cap tinh, cd the cd con dau ngan ket hgp vdi di mira, sdt va dau hg sudn phdi. Ngodi ra cdn cd trieu chiing nghet dudng mat cap, gidm can va hg sudn phai an dau thudng xay ra. Cd khi khdng cd trieu chiing ung thu, chi an khdng ngon, gidm can vd khdng vdng da, nhung xuat huylt tieu hod va nghet da ddy. Nhu vgy rat Iam lan vdi viem tiii mat kinh nien, ung thu tuy, viem tiii mat cip, sdi trong dudng mat hay cd tlii mat bi nghet lam cho tiii mat li nude [ 1 ].
Dinh benh khd, do Idn Idn vdi viem bii mat cap tinh do sdi ket cd. Ngudi bi sdi mat cd ti le ung thu tui mit cao gdp 7 lan khdng cd sdi. O thanh phd Ho Chi Minh, ngudi cd sdi tiii mat bi ung thu gip 2 lin ngudi khdng sdi. Tiii mat cd hmh dnh sdnh hod hay poljTi Idn 1 cm ciing thudng bi ung thu. Tren hmh dnh sieu am, thiy thanh tiii mgt khdng ddu, thdnh tiii mdt day mgt chd, hay u Idn bung ra trong tiii mdt tii trong thdnh. CT scan cd thi ddnh gia giai dogn khdi u nhu u xdm lin phiic mgc, di can gan, xam Idn hach vung. Khi u sd dugc d ha sudn phdi xdm lan gan, u chen ep dudng mat gdy vdng da tac mat thi da qud tri [9,19].
Md budu chinh Id adenocarcinoma. Ban dau phat triln trong long tiii mat tii niem mgc, rdi di can hach din cudng gan, gan vd cac bd phgn d gin. 6 giai dogn IIIB mdi cd hgch duong tinh.
sdt, 5 TH noi Igi mat mgt, 2 TH noi vi trang, 1 TH md ong gan ra da.
Nhu vgy, sau 2 nam ti 1? sdng sdt Id 35 (44%), ti le s6ng khdng tdi phdt Id 26 (32,5%).
- Hod trj: Chiing tdi cho hod trj bing 5FU vd mudi platine, hi?u qud khdng dugc kilm chiing.
Khi dinh b?nh dugc, 25% tmdng hgp ung thu cdn nim trong thdnh tiii mat, 35% cd kit hgp vdi di can hach viing hay xam lan cdc tgng Idn cdn vd 40% da di cdn xa [5,14,16,18,21].
Di can theo kinh diln, tir hach tgi chd, den hgch dudng mat, rdi gan vd cdc bg phgn Ian cgn cho nen phdi ngo hgch dudng mat dgc OMC vd ron gan. Xam lan gan bing cdch di can tryc tiep tii giudng tui mat, theo dudng mgch mau, bach huyet he cira hay di can xa theo dudng mdu.
Phdu thudt khi khdi u cdn trong tiii mdt thi dua vao giai doan benh [6]. Benh nhan ma khdi u cdn nam trong niem mgc hay dudi niem (Tia) hay khdi u nim trong co (Tib), sdng qua 5 nam Id 100% den 85%, do cat bd tiii mat md [2,3,8]. cit tlii mat qua ndi soi cd the 1dm roi vai te bdo ung thu trong d bung vd d port site, ke cd khi khdi u cdn d Tl chi tii 26 den 36%
[20]. Neu cdt tiii mat ngi soi thi nen chuyen md vd khoet ludn Id troca [5,18,21 ]. Tai BV chiing tdi, d cac trudng hgp Tl, T2 cdc BS thudiig cit qua ndi soi [14,16]. Tren nguyen tac, trudng hgp T2, T3 phai md lai md, hay md md ngay tii ddu.
Theo kinh diln, neu u d T2 va T3 thi phai cat tlii mat md rgng, ngo hach, ddn luu OMC hay ndi mat mdt Roux-Y. Khi ung thu tui mat xam lin gan thi phdi cit gan qud 2 cm. Neu khdi u to, thi nen cdt gan theo giai phau hgc [14,11,12,15].
Khi khdi u xdm lin dudng mat, mgch mau gay vdng da, khi khdi khong thi cit bd dugc thi nhd ngi soi hay dgt stent qua da, sieu am hudng din.
Cdn chdng dau thi cd the cat than kinh giao cam nguc qua ngi soi hay chich lidocain qua didnh byng vdo dam rdi giao cam thdn kinh tgng [3].
Ddi vdi hod tri thi chiing tdi cd dieu tri vdi 5FU vd cisplatinum nhung khdng chiing minh dugc kit qua, con xa tri thi chiing tdi chua xu dung.
50 TspchiHANMATVl$TNAMs62l-2012
Benh nhan bj ung thu toi m$t d niem mjc hay d lamina propria (Tia), tien lugng rit t6t, nhung djnh b?nh rit khd; khi kh6i u vio trong CO (Tib), ti le s6ng qua 10 nim khdng khic khi cit toi mat dgn thuin hay nao h?ch. Khi khoi u T2, nao hach trir cin tidn lugng t6t han khdng 5. K^t lu^n
Ung thu toi mat 14 ung thu njng.
Khi den sdm, tripu chimg gidng nhu vidm till mat cip hay man. Khi den imipn da cd khdi u d HSP gay trieu chimg chdn dp dudng mil hay di ciin gan.
Can de phdng khi cat toi mat ndi soi, die Tii li^u tham k h i o :
1 Aldouri AQ, Malik HZ, Waylt J ct al (2009): The risk of gallbladder cancer from polyps in a large multiethnic .scries Eur J Oncol
2. Bartlett DL, Fong Y, Fortner J O et al (1996): Long term result after resection for gallbladder cancer. Implications for staging and management. Ann surg 224.639-646.
3 Chari RS, Shad SA (2008): Biliary System, Sabislon Textbook of Surgery. IS"" edit.
pplS79-IS62
4. Cho SY, Park SJ, Kim SH et al (2010):
Analysis between clinical outcomes of pri- mary radical resection and second completion radical resection for T2 gallbladder cancer:
single -center experience. World J Surg 34:
I572-I57S
5. Choi SB, Han HJ, Kim CY ct al (2009):
Incidental gallbladder cancer diagnosed fol- lowing laparoscopic cholecystectomy. World J Surg 33:2657-2663.
6. Dixon E, Volmcr CM Jr, Sahajpad A ct al (2005): An aggressive surgical approach leads to improve survival in patients with gallblad- der cancer. A 12-year study at a North Ameri- can center. Ann surg 241,385-394.
7. Dirvng van Hai, Van Tan (2005): Budc diu NC su lien h? giira soi mat v i ung thu toi mil.TCYhocTP HCM. phu bdn Idp 9, so 4lr 289.297
8. Du-ffng Van Hai, Van T i n (2006): UT toi mat: iCinh nghiem 263 TH PT d BV Binh Dan Tgp chi KH TH VN: tap I. sd 3. tr 69- 74.
9. Foster JM, Hoshi H, Glbbs J F et al (2007):
nio hsich. Sdng 5 nim 50-60% so vdi 17-19%
mA binh thudng [6,10]. Khi khdi khdng cit bd dugc ngudi hdnh chi sdng dugc to 1 ddn 3 thing. Ndi chung sdng qua 5 nim cho toan nhdm It hon 15% [3].
bift li nhihig ca da bj vidm tdi mat kinh nien hay cip tinh, apxe hay viem phuc mac khu tni, cit toi m^t mi khdng dd ^ lim vung rai te bio ung Ihu. Khi buihi d T2, ndn md md, cit tui mjlt ngo hach t^n gdc, cat cic bd phin an lan.
Tidn lutping nhiing trudng hgp T3 thudng xiu.
Gallbladder cancer: defining the indications for primary radical resection and radical re- resection. Ann Surg Oncol I4(2):833-S40.
10. Fong Y, Jarnagin W, Blumgart IH (2000):
Gallbladder cancer. Comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann surg 232. 557-569.2000.
11. Goetzc TO, Paolucci V (2008): Benefits of reoperation of T2 and more advanced inci- dental gallbladder carcinoma: analysis of the German regisUy. Ann Surg 247(1): 104-108 12. Kai M, Chijiiwa K, Ohuchida J et al
(2007): A curative resection improves the postoperative survival rate even in patients with advanced gallbladder cancer. J Gaslrain- leslSurg 11(8): 1025-1032
13. MckeelKL, Hemming AW (2007): Surgical management of gallbladder cancer: a review.
J Gastrointest Surg 11(9): 1188-1193.
14. Misra MC, Guleria S (2006): Management of gallbladder cancer found as a surprise on a resected gallbladder specimen. J Surg Oncol 93(8):690-698.
15. Rcddy SK, Marroquin CE, Kuo PC et al (2007): Extended hepatic resection for gall- bladder cancer. Am J Surg I94(3):355-361.
16. Shih SP, Schulick RD, Cameron JL et al (2007): Gallbladder cancer, the role of laparoscopy and radical resection. Ann surg 245(6):893-901.
17. SikoraSS,SinghRK(2006): Surgicalsttate- gies in patients with gallbladder cancer . J Surg Oncol 93(8): 670-681,
Tap chi OAN MAT VIETNAM so 21-2012 51
18. Toyonaga T, Chijiiwa K, Nakao K ct al (2003): Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg 27(3):266-271.
ig. Van Tin, Dirffng van Hii (2005): Ung thu tii mat: Dac diem, dieu trj va kel qui: K IIQC Viet Nam. Tdp310,sdS,trl00-108.3S(l):48-
51.
20. Van Tan ct al (2006): Trocar-site metastasis after LC: 2 cases reported. ELS A 2006,19-21 Oct Seoul. Poster 027, Abstract bookp 187.
21. Yildirum E, Celcn O, Gulben K et al (2005): The surgical management of inciden- tal gallbladder carcinoma. Eur J Surg Oncol 31(0:45-52.
