Liver and Transplant Division, Hospital Dr Cosme Argerich, Buenos Aires, Argentina.
HPB (Oxford). 2012 Aug;14(8):548-53. doi: 10.1111/j.1477-2574.2012.00498.x. Epub 2012 Jun 8.
In patients diagnosed with incidental gallbladder cancer (GC), the benefit and optimal extent of further surgery remain unclear. The aims of this study were to analyse outcomes in patients who underwent liver resection following a diagnosis of incidental GC and to determine factors associated with longterm survival.
A retrospective analysis of patients diagnosed with incidental GC between June 1999 and June 2010 was performed. Data covering demographics, clinical and surgical characteristics and local pathological stage were analysed.
A total of 24 patients were identified. All patients underwent a resection of segments IVb and V and lymphadenectomy. Histological examination revealed residual disease in 10 patients, all of whom presented with recurrent disease at 3-12 months. Overall 5-year survival was 53%. Increasing T-stage (P < 0.001), tumour-node-metastasis (TNM) stage (P= 0.003), and the presence of residual tumour in the resected liver (P < 0.001) were all associated with worse survival.
Aggressive re-resection of incidental GC offers the only chance for cure, but its efficacy depends on the extent of disease found at the time of repeat surgery. The presence of residual disease correlated strongly with T-stage and was the most relevant prognostic factor for survival in patients treated with curative resection.
在诊断为偶发胆囊癌（GC）的患者中，进一步手术的获益和最佳范围仍不清楚。本研究旨在分析诊断为偶发 GC 后接受肝切除术患者的结局，并确定与长期生存相关的因素。
对 1999 年 6 月至 2010 年 6 月期间诊断为偶发 GC 的患者进行回顾性分析。分析数据包括人口统计学、临床和手术特征以及局部病理分期。
共确定 24 例患者。所有患者均行 IVb 段和 V 段切除术及淋巴结清扫术。组织学检查显示 10 例患者有残留病灶，所有患者均在 3-12 个月时出现复发性疾病。总体 5 年生存率为 53%。T 分期增加（P<0.001）、肿瘤-淋巴结-转移（TNM）分期（P=0.003）和肝切除标本中存在残留肿瘤（P<0.001）均与生存较差相关。
积极再次切除偶发 GC 是唯一治愈的机会，但疗效取决于重复手术时发现的疾病程度。残留疾病的存在与 T 分期密切相关，是接受根治性切除术治疗的患者的最相关预后因素。
