Department of Surgery, Hospital of Liestal, 4410, Liestal, Switzerland.
Surg Endosc. 2010 Sep;24(9):2281-6. doi: 10.1007/s00464-010-0952-y. Epub 2010 Feb 23.
Little is known about the long-term survival of patients with incidental gallbladder carcinoma (IGBC). The role of radical resection for this disease is discussed controversially in the literature. We present the long-term survival and the results of re-resection versus simple cholecystectomy of the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) from 1994 to 2004.
Eighty-nine patients with histologically confirmed carcinoma of the gallbladder were identified out of 30,960 patients undergoing laparoscopic cholecystectomy. Sixty-nine patients were included in our study. Long-term survival by different T-stage and comparison of patients with extended resection versus simple cholecystectomy were calculated using the log-rank test. The time-to-event data are demonstrated by Kaplan-Meier curves.
The overall incidence of IGBC in patients who underwent laparoscopic cholecystectomy was 0.28% (89 of 30,960). Fifty patients underwent simple cholecystectomy [n = 2: carcinoma in situ (CIS); n = 2: pT1a; n = 10: pT1b; n = 23: pT2; n = 8: pT3; n = 5: pT4], whereas extended resection was performed in 19 cases (n = 2: pT1b; n = 11: pT2; n = 6: pT3). The comparison of simple cholecystectomy versus extended re-resection of the gallbladder bed and regional lymph node resections showed a significant benefit in overall survival for the pT2 and pT3 group (p < 0.05). The pT1b group showed no significant benefit in overall survival (p = 0.34).
IGBC has a low incidence (0.28%). We present a large study of patients with IGBC, comparing the overall survival by different histological findings. We observed a significant benefit for the group with pT2 and pT3. Therefore we recommend extended resection of the gallbladder bed and the regional lymph nodes for patient with incidental histologically confirmed pT2 and pT3 carcinoma of the gallbladder after performance of laparoscopic cholecystectomy. For patients with pT1b stage no recommendations can be given based on this study.
偶发胆囊癌（IGBC）患者的长期生存情况鲜为人知。根治性切除术在该疾病中的作用在文献中存在争议。我们展示了瑞士腹腔镜和胸腔镜外科协会（SALTS）数据库中 1994 年至 2004 年的长期生存情况和再次切除与单纯胆囊切除术的结果。
在 30960 例腹腔镜胆囊切除术中发现 89 例组织学证实的胆囊癌患者。69 例患者纳入本研究。不同 T 分期的长期生存率和广泛切除术与单纯胆囊切除术患者的比较采用对数秩检验进行计算。时间事件数据通过 Kaplan-Meier 曲线表示。
接受腹腔镜胆囊切除术的患者中偶发胆囊癌的总体发生率为 0.28%（89/30960）。50 例患者行单纯胆囊切除术[2 例：原位癌（CIS）；2 例：pT1a；10 例：pT1b；23 例：pT2；8 例：pT3；5 例：pT4]，19 例患者行扩大切除术（2 例：pT1b；11 例：pT2；6 例：pT3）。单纯胆囊切除术与胆囊床和区域淋巴结切除的扩大再切除术的比较显示，pT2 和 pT3 组的总体生存率有显著获益（p<0.05）。pT1b 组的总体生存率无显著获益（p=0.34）。
IGBC 的发病率较低（0.28%）。我们进行了一项关于偶发胆囊癌患者的大型研究，比较了不同组织学发现的总体生存率。我们观察到 pT2 和 pT3 组有显著获益。因此，我们建议对经腹腔镜胆囊切除术后病理证实的偶发性 pT2 和 pT3 胆囊癌患者行胆囊床和区域淋巴结的扩大切除术。基于本研究，对于 pT1b 期的患者，我们无法提出任何建议。
