Incidental Gallbladder Cancer by the AFC-GBC-2009 Study Group
Incidental Gallbladder Cancer by the AFC-GBC-2009 Study Group
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DOI：
10.1007/s00268-011-1134-3
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发表时间：
2011-08-01
影响因子：
2.6
通讯作者：
Farges, Olivier
中科院分区：
文献类型：
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作者：
Fuks, David;Regimbeau, Jean Marc;Farges, Olivier
背景：由于良性疾病而行胆囊切除术时，常在标本上发现偶发胆囊癌（GBC）。本研究的目的是评估在法国注册的偶然GBC患者的管理。方法回顾性整理1998 - 2008年法国多中心数据库中GBC患者的治疗资料。结果共纳入218例偶发GBC患者（男性67例，女性151例，中位年龄64岁，年龄范围31-88岁）。148例（68%）患者在中位间隔48天（范围2-245天）后接受了再次切除。最常见的完整手术（66%的病例）是4b + 5节段切除术加淋巴结切除术，但不包括胆管切除术。54例患者行Port-site切除术。死亡率为3%，发病率为37%。切除胆总管（43%）增加了术后并发症（60 vs 23%, p = 0.0001）。局部残余肿瘤83例（56%）；与T期显著相关，并影响长期生存。143例（97%）患者获得R0, 1例（1.8%）患者经组织学证实肝部位侵犯。在中位随访34个月后，148例再次切除患者的1年、3年和5年生存率分别为76.4%、54.4%和41%。再次切除可显著提高T2 （p = 0.0001）和T3 （p = 0.04）患者的生存率。切除总胆管既不能提高R0切除，也不能提高总生存率（p = 0.06）。结论本研究验证了T2和T3 GBC再切除的概念。胆管切除术增加了术后发病率，但不能提高生存率。目前，对偶发性GBC的手术治疗有一种修改，即小范围切除肝脏，不切除总胆管。
Background Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry.Methods Data on patients with GBC treated between 1998 and 2008 were retrospectively collated in a French, multicenter database.Results The registry contained 218 patients with incidental GBC (67 men and 151 women; median age = 64 years; age range = 31-88). One hundred forty-eight (68%) patients underwent re-resection after a median time interval of 48 days (range = 2-245). The most common complete procedure (66% of cases) was 4b + 5 segmentectomy with lymphadenectomy but not bile duct resection. Port-site excision was performed in 54 patients. The mortality and morbidity rates were 3 and 37%, respectively. Resection of the common bile duct (43%) increased postoperative complications (60 vs. 23%, p = 0.0001). Local residual tumor was found in 83 (56%) patients; it was significantly correlated with the T stage and influenced long-term survival. R0 was obtained in 143 (97%) patients and port-site invasion was histologically confirmed in one patient (1.8%). After a median follow-up period of 34 months, the 1-, 3-, and 5-year survival rates for the 148 patients with re-resection were 76, 54, and 41%, respectively. Re-resection significantly increased survival in patients with T2 (p = 0.0001) and T3 (p = 0.04) disease. Resection of the common bile duct increased neither R0 resection nor overall survival (p = 0.06).Conclusion This study validates the concept of re-resection in T2 and T3 GBC. Bile duct resection increases postoperative morbidity but does not improve survival. There is currently a modification in the surgical management of incidental GBC, with minor liver resection and no common bile duct resection.