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Introduction: The early cancer of gallbladder is an entity which is not well
recognized currently. It is a cancer which does not extend beyond the
muscularis layer of the gallbladder and it is characterized in almost of cases
by the absence of lymph node and visceral invasion. Patients and Method: We have conducted this retrospective study of
all our cases of early gallbladder cancer treated in our surgical unit. We have
studied these through clinical, morphological, therapeutical and evolutionary
aspects. Results: Of 202 gallbladder
carcinoma, 33 cancers were classified as early cancer. 25 were females and 8
were males. The mean age was 56.4 years (41 - 70 years).
All patients were free of gallbladder cancer symptoms and all except one had
normal CEA and CA19.9. 2 patients had synchronous tumors (one colonic cancer
and one rectal cancer). For 16 patients, the diagnosis was
done by ultrasonography and 17 by histological examination of the specimen
removed for biliary lithiasis. 8 patients had PT1a tumor (confined only to
mucosa) and 25 had PT1b tumor (tumor infiltration of the muscular layer). For
19 patients who benefited from extensive lymphadenectomy, only
one (5.3%) had lymph node infiltration. 16 patients had a simple
cholecystectomy and in two cases, the cholecystectomy was associated with bile
duct resection. 17 patients had hepatectomy with extensive lymphadenectomy.
The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi; Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.