The role of laparoscopic staging in patients with incidental gallbladder cancer
The role of laparoscopic staging in patients with incidental gallbladder cancer
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DOI：
10.1111/j.1477-2574.2011.00325.x
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发表时间：
2011-07-01
期刊：
影响因子：
2.9
通讯作者：
Jarnagin, William R.
中科院分区：
文献类型：
--
作者：
Butte, Jean M.;Goenen, Mithat;Jarnagin, William R.
背景：腹腔镜手术（SL）在偶发性胆囊癌（IGBC）患者中的分期作用尚不明确。本研究评估SL的效用，目的是确定与播散性疾病（DD）相关的变量。方法：从前瞻性数据库中确定了1998年至2009年期间接受再探查的IGBC患者。计算了SL的产率和准确度。人口统计学，肿瘤和治疗相关的变量与DD的结果。结果：136例患者提交重新探索可能的最终切除，19（14.0%）DD。46例（33.8%）患者进行了分期腹腔镜检查，其中10例（21.8%）患有DD（腹膜疾病[n = 6]，肝转移[n = 3]，腹膜后疾病[n = 1]）。SL在2名患者中发现了弥漫性疾病（产率= 4.3%），而8名患者在转为剖腹手术后被诊断出（准确率= 20.0%）。DD的可能性与T分期密切相关（T1 b，n = 0; T2，n = 5 [7.0%]，T3，n = 14 [26.0%]; P = 0.004）。初次胆囊切除术时切缘阳性（比值比[OR] 5.44，95%置信区间[Cl] 1.51-24.37; P = 0.004）和肿瘤分化（OR 7.64，95%CI 1.1-NA; P = 0.006）是多变量分析中DD的独立预测因素。在IGBC患者中，播散性疾病相对少见，SL的产率非常低。然而，低分化、T3或切缘阳性的胆囊肿瘤患者发生DD的风险较高，针对这些患者可能会增加SL的发生率。
dBackground: The role of staging laparoscopy (SL) in patients with incidental gallbladder cancer (IGBC) is ill defined. This study evaluates the utility of SL with the aim of identifying variables associated with disseminated disease (DD).Methods: Consecutive patients with IGBC who underwent re-exploration between 1998 and 2009 were identified from a prospective database. The yield and accuracy of SL were calculated. Demographics, tumour- and treatment-related variables were correlated with findings of DD.Results: Of the 136 patients submitted to re-exploration for possible definitive resection, 19 (14.0%) had DD. Staging laparoscopy was carried out in 46 (33.8%) patients, of whom 10 (21.8%) had DD (peritoneal disease [n = 6], liver metastases [n = 3], retroperitoneal disease [n = 1]). Disseminated disease was identified by SL in two patients (yield = 4.3%), whereas eight were diagnosed after conversion to laparotomy (accuracy = 20.0%). The likelihood of DD correlated closely with T-stage (T1b, n = 0; T2, n = 5 [7.0%], T3, n = 14 [26.0%]; P = 0.004). A positive margin at initial cholecystectomy (odds ratio [OR] 5.44, 95% confidence interval [Cl] 1.51-24.37; P = 0.004) and tumour differentiation (OR 7.64, 95% CI 1.1-NA; P = 0.006) were independent predictors of DD on multivariate analysis.Discussion: Disseminated disease is relatively uncommon in patients with IGBC and SL provides a very low yield. However, patients with poorly differentiated, T3 or positive-margin gallbladder tumours are at high risk for DD and targeting these patients may increase the yield of SL.