World J. Surg. 16, 364, 1992
World Journal of Surgery D 1992by the Soci~.16 lnternationale de Chirurgic
Letters to the Editor
To the Editor With reference to the article titled "Palliative Operative Procedures for Carcinoma of the Gallbladder", World J. Surg. •5:348, 1991, I would like to share our experience of palliative surgery for cancer of the gallbladder which is endemic in northern India (unpublished data). We have diagnosed 112 cases of carcinoma of the gallbladder from January, 1989 to August, 1991. Most (97%) of these patients are Nevin's stages IV and stage V. In 1 patient, extended cholecystectomy with wedge excision of liver and bile duct excision was performed. Palliative procedures were performed in 32 patients in the form of simple cholecystectomy (n = 8), bypass procedures like segment III duct hepaticojejunostomy (n = 14), gastrojejunostomy (n = 10), ileotransverse colostomy (n = 2), choledochoduodenostomy (n = 1), and cholecystostomy (n = 1). Resection in the form of simple cholecystectomy provided better palliation than bypass procedures in similar stages of disease. Following simple cholecystectomy, mean survival was 13 months and 5 patients remained symptom-free for a period of
5-22 months (mean, 11 months). Segment III duct hepaticojejunostomy was performed for palliation of jaundice associated with symptoms of cholangitis and/or pruritus. Jaundice improved in all patients but cholangitis and pruritus each persisted in 2 patients. Mean survival after segment III duct hepaticojejunostomy was 4.8 months while it was 3.7 months following gastrojejunostomy done for manifest gastric outlet obstruction. Prophylactic gastrojejunostomy was added to hepaticojejunostomy in 8 patients and did not add to the morbidity of the procedure. In addition, cholecystojejunostomy was also added to hepaticojejunostomy to drain the obstructed gallbladder. Thus we conclude that palliation, either in the form of restriction or bypass, is possible in a significant proportion of advanced cancers of the gallbladder. Sandeep Awasthi, M.S. Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, India
World Journal of Surgery D 1992by the Soci~.16 lnternationale de Chirurgic
Letters to the Editor
To the Editor With reference to the article titled "Palliative Operative Procedures for Carcinoma of the Gallbladder", World J. Surg. •5:348, 1991, I would like to share our experience of palliative surgery for cancer of the gallbladder which is endemic in northern India (unpublished data). We have diagnosed 112 cases of carcinoma of the gallbladder from January, 1989 to August, 1991. Most (97%) of these patients are Nevin's stages IV and stage V. In 1 patient, extended cholecystectomy with wedge excision of liver and bile duct excision was performed. Palliative procedures were performed in 32 patients in the form of simple cholecystectomy (n = 8), bypass procedures like segment III duct hepaticojejunostomy (n = 14), gastrojejunostomy (n = 10), ileotransverse colostomy (n = 2), choledochoduodenostomy (n = 1), and cholecystostomy (n = 1). Resection in the form of simple cholecystectomy provided better palliation than bypass procedures in similar stages of disease. Following simple cholecystectomy, mean survival was 13 months and 5 patients remained symptom-free for a period of
5-22 months (mean, 11 months). Segment III duct hepaticojejunostomy was performed for palliation of jaundice associated with symptoms of cholangitis and/or pruritus. Jaundice improved in all patients but cholangitis and pruritus each persisted in 2 patients. Mean survival after segment III duct hepaticojejunostomy was 4.8 months while it was 3.7 months following gastrojejunostomy done for manifest gastric outlet obstruction. Prophylactic gastrojejunostomy was added to hepaticojejunostomy in 8 patients and did not add to the morbidity of the procedure. In addition, cholecystojejunostomy was also added to hepaticojejunostomy to drain the obstructed gallbladder. Thus we conclude that palliation, either in the form of restriction or bypass, is possible in a significant proportion of advanced cancers of the gallbladder. Sandeep Awasthi, M.S. Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, India
