Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis
Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis
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DOI：
10.3748/wjg.v21.i4.1315
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发表时间：
2015-01-28
影响因子：
4.3
通讯作者：
Choi, Sang Yong
中科院分区：
文献类型：
--
作者：
Choi, Kui Sun;Choi, Sae Byeol;Choi, Sang Yong
目的：对胆囊切除术中或术后诊断的偶发或意外胆囊癌进行系统综述。方法：查阅PubMed、EMBASE和Cochrane图书馆的数据，纳入荟萃分析的文献有26篇。偶发性胆囊癌的纳入标准是在术前阶段未被怀疑的在胆囊切除术中或之后诊断的胆囊癌。分析偶发GB癌的发生率、T分期分布和再次手术的比例。结果：最终汇集的人群包括2145例偶发GB癌患者。良性胆囊病患者术前诊断时偶发胆囊癌的比例为0.7%(95%CI：0.004~0.012)。近50%的偶发GB癌为T2期，合并比例为47.0%(95%CI：0.421-0.519)。T1和T3 GB癌的发生率相似，其合并比例分别为23.0%(95%CI：0.178-0.291)和25.1%(95%CI：0.195-0.317)。为治疗目的而完成翻修手术的合并比例为40.9%(95%CI：0.329-0.494)。复发手术后不能切除疾病的患者比例为23.0%(95%CI：0.177-0.294)。结论：偶发的GB癌中有很大比例是T2和T3病变。对于T2和更晚期的癌症，有必要进行根治性胆囊切除术的翻修手术。
AIM: To perform a systematic review of incidental or unsuspected gallbladder (GB) cancer diagnosed during or after cholecystectomy.METHODS: Data in PubMed, EMBASE, and Cochrane Library were reviewed and 26 publications were included in the meta-analysis. The inclusion criterion for incidental GB cancer was GB cancer diagnosed during or after cholecystectomy that was not suspected at a preoperative stage. Pooled proportions of the incidence, distribution of T stage, and revisional surgery of incidental GB cancer were analyzed.RESULTS: The final pooled population comprised 2145 patients with incidental GB cancers. Incidental GB cancers were found in 0.7% of cholecystectomies performed for benign gallbladder diseases on preoperative diagnosis (95%CI: 0.004-0.012). Nearly 50% of the incidental GB cancers were stage T2 with a pooled proportion of 47.0% (95%CI: 0.421-0.519). T1 and T3 GB cancers were found at a similar frequency, with pooled proportions of 23.0% (95%CI: 0.178-0.291) and 25.1% (95%CI: 0.195-0.317), respectively. The pooled proportion that completed revisional surgery for curative intent was 40.9% (95%CI: 0.329-0.494). The proportion of patients with unresectable disease upon revisional surgery was 23.0% (95%CI: 0.177-0.294).CONCLUSION: A large proportion of incidental GB cancers were T2 and T3 lesions. Revisional surgery for radical cholecystectomy is warranted in T2 and more advanced cancers.