Tomimaru Yoshito, Noguchi Kozo, Nagase Hirotsugu, Hamabe Atsushi, Hirota Masashi, Oshima Kazuteru, Tanida Tsukasa, Kawase Tomono, Morita Shunji, Imamura Hiroshi, Iwazawa Takashi, Akagi Kenzo, Dono Keizo
Dept. of Surgery, Toyonaka Municipal Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1605-1607.
The aim of this study was to clarify the clinicopathological characteristics of incidental gallbladder cancer(iGBC)diagnosed after laparoscopic cholecystectomy. A total of 33 patients diagnosed with iGBC were enrolled in this study, and their clinicopathological characteristics were investigated. Preoperative diagnoses were as follows: cholelithiasis in 16 patients, polypoid lesions in 8, cholecystitis in 7, and adenomyomatosis in 2. Depth of mural invasion of iGBC was M in 14 cases, MP in 3, SS in 12, and deeper than SS in 4. M/MP cases with negative margins were followed up, and cases with SS/deeper than SS underwent additional resection. Prognosis of these patients with iGBC was not significantly different from that of non-iGBC (niGBC)patients. There was no significant difference in R2 resection rate between iGBC and niGBC with SS/deeper than SS. Intriguingly, peritoneal dissemination was identified on additional resection in 1 case that had intraoperative bile leakage at the prior laparoscopic cholecystectomy. Port-site recurrence was found in 2 iGBC cases. These results suggested that the treatment strategy for iGBC is acceptable. However, considering the existence of cases with peritoneal dissemination or portsite recurrence, the possible presence of iGBC should be kept in mind at the initial laparoscopic cholecystectomy.
本研究的目的是阐明腹腔镜胆囊切除术后诊断出的意外胆囊癌（iGBC）的临床病理特征。本研究共纳入33例诊断为iGBC的患者，并对其临床病理特征进行了调查。术前诊断如下：16例为胆结石，8例为息肉样病变，7例为胆囊炎，2例为腺肌增生症。iGBC的壁层浸润深度为M期14例，MP期3例，SS期12例，SS期以上4例。对切缘阴性的M/MP期病例进行随访，对SS期/SS期以上病例进行追加切除。这些iGBC患者的预后与非iGBC（niGBC）患者无显著差异。iGBC与SS期/SS期以上的niGBC在R2切除率上无显著差异。有趣的是，在1例先前腹腔镜胆囊切除术中出现术中胆汁漏的病例中，追加切除时发现了腹膜播散。2例iGBC病例发现了端口部位复发。这些结果表明iGBC的治疗策略是可接受的。然而，考虑到存在腹膜播散或端口部位复发的病例，在初次腹腔镜胆囊切除时应牢记可能存在iGBC。
