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INTRODUCTION: Gallbladder cancer (GBC) is the most incident cancer of the biliary tract with only 5-13% of the sufferers
surviving for ve years. e aim of this study was to evaluate the prognostic role of perineural invasion (PNI)
and its association with several clinicopathological variables in a cohort of surgically treated patients, and through a comprehensive
review of the scientic literature.
MATERIALS AND METHODS: Twenty-ve consecutive patients submitted to curative surgery for GBC from 2008 through
2016 were enrolled. Demographic, clinical and pathological data were retrieved from medical les, and specimens were
re-examined by two experienced pathologists. e Pubmed database was searched for articles reporting on perineural inltration
on gallbladder cancer.
RESULTS: Perineural invasion was observed in 14 (56%) cases, and it was more frequent in higher pathological stages.
A statistically signicant association was found with high preoperative serum Ca 19-9 levels. Fourteen (56%) patients
died during the follow-up; survival was lower in patients with perineural invasion in comparison to those without, but
not statistically signicant. Twelve English-language articles reporting on PNI were retrieved and discussed.
CONCLUSIONS: Perineural invasion is associated with higher stage and poorer survival in surgically treated GBC patients.
In patients with locally advanced GBC resection of the extrahepatic biliary duct and frozen section examination of the
distal stump must be taken into consideration, especially in cases of tumor arising from the hepatic side of the gallbladder.
In cases without residual disease but with pathological evidence of PNI, a careful follow-up is suggested to early