Cucinotta Eugenio, Lorenzini Cesare, Melita Giuseppinella, Iapichino Giuliano, Currò Giuseppe
Department of Human Pathology, University of Messina, Messina, Italy.
ANZ J Surg. 2005 Sep;75(9):795-8. doi: 10.1111/j.1445-2197.2005.03528.x.
The aim of the study was to evaluate the outcome in patients with unsuspected gall bladder carcinoma diagnosed after cholecystectomy, comparing the laparoscopic approach with open surgery.
A retrospective study was done of 16 patients who were diagnosed with unsuspected gall bladder carcinoma out of the 2850 who had undergone cholecystectomy for symptomatic cholelithiasis at our institution between 1990 and 2004. Eight cases (seven women and one man, mean age 63 (range 49-75 years) ) were diagnosed after laparoscopic cholecystectomy (group A) and eight cases (six women and two men, mean age 63 (range 50-79 years) ) after open cholecystectomy (group B). We evaluated the outcome in the two groups correlating the cumulative survival rates with tumour stage and surgical technique.
In group A, three patients had port-site recurrence (1 pT1a and 2 pT1b tumours) after 6, 7 and 9 months, one had intraperitoneal dissemination (pT2) after 3 months, and four had no recurrence (1 pTis, 2 pT1a and 1 pT1b). In group B, five patients had recurrences (4 pT1b and 1 pT2) after an average of 8 months (range 5-11) and three had no recurrence (1 pTis and 2 pT1a). Survival rate was statistically correlated with tumour stage but not with the surgical approach used to perform cholecystectomy.
The surgical approach used for cholecystectomy would seem not to influence the outcome in patients with unsuspected gall bladder carcinoma. The tumour stage is the most important prognostic factor.
本研究旨在评估胆囊切除术后诊断为意外胆囊癌患者的预后情况，比较腹腔镜手术与开放手术的效果。
对1990年至2004年间在我院因有症状胆结石行胆囊切除术的2850例患者中诊断为意外胆囊癌的16例患者进行回顾性研究。8例患者（7例女性和1例男性，平均年龄63岁（范围49 - 75岁））在腹腔镜胆囊切除术后确诊（A组），8例患者（6例女性和2例男性，平均年龄63岁（范围50 - 79岁））在开放胆囊切除术后确诊（B组）。我们评估了两组的预后情况，将累积生存率与肿瘤分期和手术技术相关联。
A组中，3例患者（1例pT1a和2例pT1b肿瘤）在6、7和9个月后出现切口部位复发，1例患者（pT2）在3个月后出现腹腔播散，4例患者无复发（1例pTis、2例pT1a和1例pT1b）。B组中，5例患者（4例pT1b和1例pT2）平均在8个月（范围5 - 11个月）后出现复发，3例患者无复发（1例pTis和2例pT1a）。生存率与肿瘤分期有统计学相关性，但与进行胆囊切除术所采用的手术方式无关。
用于胆囊切除术的手术方式似乎不影响意外胆囊癌患者的预后。肿瘤分期是最重要的预后因素。
