Unsuspected Gallbladder Cancer Diagnosed After Laparoscopic Cholecystectomy: Focus on Acute Cholecystitis
Unsuspected Gallbladder Cancer Diagnosed After Laparoscopic Cholecystectomy: Focus on Acute Cholecystitis
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DOI：
10.1007/s00268-009-0279-9
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发表时间：
2010-01-01
影响因子：
2.6
通讯作者：
Kim, Myung Wook
中科院分区：
文献类型：
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作者：
Kim, Ji Hun;Kim, Wook Hwan;Kim, Myung Wook
本研究旨在探讨腹腔镜胆囊切除术（LC）后诊断为未发现胆囊癌（UGC）患者的临床病理特征，并阐明急性胆囊炎（AC）与未发现胆囊癌的关系。1997年6月至2008年3月，在亚洲大学医学中心共进行了2,607例LCs手术。术后诊断为胆囊癌26例（1.0%）。我们排除了术前或术中疑似胆囊癌的患者。在1128例AC患者中，19例（1.6%）术后确诊为胆囊癌。术前诊断急性和重度急性胆囊炎发生率高（n = 19; 73.1%）。转行开腹手术的比例为15.4%(4/26)，26例患者中有14例发生胆汁溢出（53.8%）。腺癌（92.3%）和pT2（65.4%）是最常见的病理表现。在19例UGC合并AC的患者中，最常见的病理表现也是pT2 （n = 12; 63.1%）。此外，5例切缘阳性患者均属于UGC伴AC组。26例患者中有2例（7.7%）在LC后接受了额外的手术，2例（7.7%）因复发而切除了端口/伤口。总中位生存期为32个月（95%置信区间[CI] = 21-43）。在年龄、有无急性胆囊炎、胆汁外溢等方面差异无统计学意义（P < 0.05），但肿瘤分化与生存率显著相关。术前诊断为高发急性及重度急性胆囊炎。生存与AC和胆汁溢出的存在无关。因此，我们认为AC可能不会影响LC后未确诊胆囊癌的预后。此外，良好的肿瘤分化可以保证良好的生存，即使是伴有AC的UGC。
The aim of the present study was to investigate clinicopathological features of patients who were diagnosed with unsuspected gallbladder cancer (UGC) after laparoscopic cholecystectomy (LC) and to clarify the relationship between acute cholecystitis (AC) and unsuspected gallbladder cancer.From June 1997 to March 2008, a total of 2,607 LCs were performed at Ajou University Medical Center. Twenty-six patients (1.0%) were diagnosed with gallbladder cancer after LC. We excluded patients with preoperatively or intraoperatively suspected gallbladder cancer.Of 1,128 patients with AC, 19 (1.6%) were identified with gallbladder cancer after surgery. The preoperative diagnosis included a high rate of acute and severe acute cholecystitis (n = 19; 73.1%). The rate of conversion to open surgery was 15.4% (4/26), and bile spillage occurred in 14 of 26 patients (53.8%). Adenocarcinoma (92.3%) and pT2 (65.4%) were the most common pathological findings. In 19 UGC patients with AC, the most common pathological finding was also pT2 (n = 12; 63.1%). In addition, all 5 of the patients with positive resection margin belonged to the UGC with AC group. Two of 26 patients (7.7%) underwent additional surgery after LC, and 2 patients (7.7%) underwent excision of the port site/wound for recurrence. The overall median survival was 32 months (95% Confidence Interval [CI] = 21-43). There were no significant differences in age, the presence of acute cholecystitis, or bile spillage (P > 0.05) However, tumor differentiation was associated significantly with survival rate.The preoperative diagnosis included a high rate of acute and severe acute cholecystitis. Survival was not associated with the presence of AC and bile spillage. Therefore, we suggest that AC may not influence the prognosis of unsuspected gallbladder cancer after LC. Moreover, good tumor differentiation can guarantee favorable survival, even in UGC with AC.