Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Korea University Guro Hospital, 80 Gurodong, Guro-gu, Seoul, Korea.
World J Surg. 2009 Dec;33(12):2657-63. doi: 10.1007/s00268-009-0249-2.
Laparoscopic cholecystectomy (LC) is the treatment of choice for benign gallbladder disease. Gallbladder cancers have been found following LC. The aim of the present study was to evaluate the survival outcome and prognosis of incidental gallbladder cancer diagnosed after LC.
From January 2002 to December 2007, 3,145 patients underwent LC at the Department of Surgery, Korea University Medical Center. Of these, 33 patients (1.05%) were diagnosed with gallbladder cancer after LC. Clinicopathological characteristics were retrospectively reviewed in this study.
Of the 33 patients studied, 9 were men and 24 were women. Laparoscopic cholecystectomy alone was performed in 26 patients, and additional radical surgery was performed in 7 others. Regarding tumor staging, there were 2 Tis, 6 T1a, 4 T1b, 17 T2, and 4 T3 tumors. Male patients had a significantly higher incidence of moderately and poorly differentiated tumors (P < 0.001), T2 and T3 tumors (P = 0.02), additional second operations (P = 0.046), and recurrence (P = 0.016). The cumulative 1-, 3-, and 5-year survival rates were 87.2, 73.1, and 47.0%, respectively. Univariate analysis revealed that significant prognostic factors for poorer survival were male gender (P = 0.026), age older than 65 years (P = 0.013), the presence of inflammation (P = 0.009), moderately or poorly differentiated tumor (P < 0.001), nonpolypoid gross type (P = 0.003), and pT stage (P < 0.001). Tumor differentiation was a significantly independent predictor of poor prognosis.
Male patients exhibited aggressive tumor characteristics. Laparoscopic cholecystectomy is an adequate treatment for pT1 tumors. For pT2 and pT3 patients, additional radical surgery might be needed to achieve a tumor-free surgical margin, along with lymph node dissection.
腹腔镜胆囊切除术（LC）是治疗良性胆囊疾病的首选方法。LC 后发现了胆囊癌。本研究旨在评估 LC 后诊断为偶然胆囊癌的患者的生存结局和预后。
2002 年 1 月至 2007 年 12 月，韩国大学医学中心外科共对 3145 例患者进行了 LC。其中，33 例（1.05%）LC 后诊断为胆囊癌。本研究回顾性分析了这些患者的临床病理特征。
在 33 例患者中，男性 9 例，女性 24 例。26 例患者仅行腹腔镜胆囊切除术，其余 7 例患者行根治性手术。在肿瘤分期方面，Tis 期 2 例，T1a 期 6 例，T1b 期 4 例，T2 期 17 例，T3 期 4 例。男性患者中，中、低分化肿瘤（P<0.001）、T2 和 T3 期肿瘤（P=0.02）、附加二次手术（P=0.046）和复发（P=0.016）的发生率明显更高。1 年、3 年和 5 年的累积生存率分别为 87.2%、73.1%和 47.0%。单因素分析显示，生存率较差的显著预后因素为男性（P=0.026）、年龄大于 65 岁（P=0.013）、炎症存在（P=0.009）、中、低分化肿瘤（P<0.001）、非息肉样大体类型（P=0.003）和 pT 期（P<0.001）。肿瘤分化是预后不良的显著独立预测因素。
男性患者表现出侵袭性肿瘤特征。LC 适用于 pT1 肿瘤。对于 pT2 和 pT3 患者，可能需要额外的根治性手术以获得无肿瘤手术切缘，并进行淋巴结清扫。
