Department of Surgical Sciences, Policlinico Gemelli, "A. Gemelli" Medical School, Catholic University of the Sacred Heart, Largo Gemelli 8, 00168 Rome, Italy.
J Gastrointest Surg. 2012 Aug;16(8):1462-8. doi: 10.1007/s11605-012-1915-5. Epub 2012 Jun 1.
The objective of this study is to assess the prognosis of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy for acute cholecystitis.
Data of all patients treated for unexpected gallbladder cancer after laparoscopic cholecystectomy at a tertiary care surgical center between January 1998 and December 2009 were reviewed. Demographics and clinical and pathological data of patients submitted to adjunctive revisional surgery were analyzed. Survival was calculated by the Kaplan-Meier method, and log-rank test was used to compare the survival curves. The Cox proportional hazard model was used to determine the effect on survival of urgent surgery for acute cholecystitis and of the other common factors such as age, gender, tumor grading, pT stage, nodal involvement, residual disease at re-exploration, and American Joint Committee on Cancer stage.
In the considered period, 34 patients with pT1b, pT2, or pT3 unexpected gallbladder cancer underwent a second standard revisional procedure including resection of liver segments 4b and 5, lymphadenectomy, and port-sites excision. Thirteen patients had previously undergone urgent surgery for acute cholecystitis; 21 had undergone a routine operation. The 5-year overall survival was 63.3 %. At multivariate analysis, G3 tumor grading (hazard ratio, 12.261; p = 0.002), residual disease at re-exploration [hazard ratios (HR) = 7.760, p = 0.004], and urgent surgery for acute cholecystitis (HR = 5.436, p = 0.012) were independent predictors of poor prognosis.
The prognosis of unexpected gallbladder cancer is worsened when laparoscopic cholecystectomy is performed for acute cholecystitits. The unfavorable impact of emergency surgery on prognosis might be related to intraoperative gallbladder emptying with bile spillage and cancer dissemination.
本研究旨在评估腹腔镜胆囊切除术治疗急性胆囊炎后意外胆囊癌的预后。
回顾 1998 年 1 月至 2009 年 12 月在一家三级护理外科中心接受腹腔镜胆囊切除术治疗意外胆囊癌的所有患者的数据。分析接受辅助性翻修手术的患者的人口统计学和临床病理数据。通过 Kaplan-Meier 方法计算生存率，并使用对数秩检验比较生存曲线。Cox 比例风险模型用于确定急性胆囊炎紧急手术和其他常见因素（如年龄、性别、肿瘤分级、pT 分期、淋巴结受累、再次探查时残留疾病和美国癌症联合委员会分期）对生存的影响。
在所考虑的时期内，34 例 pT1b、pT2 或 pT3 意外胆囊癌患者接受了第二次标准翻修手术，包括切除肝段 4b 和 5、淋巴结清扫术和端口切除。13 例患者曾因急性胆囊炎行紧急手术，21 例行常规手术。5 年总生存率为 63.3%。多因素分析显示，G3 肿瘤分级（危险比，12.261；p=0.002）、再次探查时残留疾病[危险比（HR）=7.760，p=0.004]和急性胆囊炎行紧急手术（HR=5.436，p=0.012）是预后不良的独立预测因素。
腹腔镜胆囊切除术治疗急性胆囊炎会使意外胆囊癌的预后恶化。急诊手术对预后的不利影响可能与术中胆囊排空导致胆汁外溢和癌症扩散有关。
