Department of Surgery, Clinica Alemana, Vitacura, 5951, Santiago, Chile.
Department of Surgery, Chilean Air Force Hospital, Santiago, Chile.
Surg Endosc. 2018 Oct;32(10):4251-4255. doi: 10.1007/s00464-018-6173-5. Epub 2018 Jun 20.
The laparoscopic cholecystectomy has allowed the detection of an increasing number of incidental gallbladder cancers (IGBC). Although laparoscopy is employed in the management of a variety of abdominal tumors, its use in gallbladder cancer is reduced and controversial. This study analyzes the role of laparoscopy in gallbladder cancer with the focus in IGBC.
We evaluated our prospective series of 51 patients with an IGBC who were treated by laparoscopy between 2006 and 2016 at the Clinica Alemana in Santiago, Chile.
The series comprised 7 men and 44 women. Age ranged from 43 to 76 years (mean age 60). Regarding wall involvement, 29 patients had a T2 tumor, which was the most common. 8 and 14 patients had T1b and T3 tumors, respectively. Of the patients, 17 underwent only laparoscopic exploration. This was due to the presence tumor dissemination not being observed in the preoperative staging. 10 patients had to be converted to complete the resection, whereas 24 patients were laparoscopically resected. The quality of the resected material was not different between those who were converted and those who were treated by laparoscopy. In the laparoscopic group, the average number of harvested lymph nodes was 7.9, not statistically different from the converted group. The mean of hospital stay in the laparoscopic group (4.3 days) was significantly lower than the converted group.
Laparoscopy has been shown to be a safe and feasible method for the management of IGBC. This method not only allows for a complete exploration, identifying a previously unseen residual tumor, but also makes it possible to accomplish the same oncology objectives as the open procedure. Therefore, laparoscopy should be considered a valid alternative in the management of IGBC.
腹腔镜胆囊切除术已允许检测到越来越多的偶发胆囊癌（IGBC）。尽管腹腔镜被用于多种腹部肿瘤的治疗，但在胆囊癌中的应用却减少了，且存在争议。本研究分析了腹腔镜在胆囊癌中的作用，重点关注 IGBC。
我们评估了我们在智利圣地亚哥的 Alemana 诊所 2006 年至 2016 年期间对 51 例 IGBC 患者进行的腹腔镜治疗的前瞻性系列研究。
该系列包括 7 名男性和 44 名女性。年龄从 43 岁至 76 岁（平均年龄 60 岁）。关于壁受累情况，29 例患者为 T2 肿瘤，最常见。8 例和 14 例患者分别为 T1b 和 T3 肿瘤。17 例患者仅行腹腔镜探查，这是由于术前分期未观察到肿瘤扩散。10 例患者需要转为剖腹手术以完成切除，而 24 例患者则行腹腔镜切除。转化组和腹腔镜组的切除标本质量无差异。在腹腔镜组中，平均采集的淋巴结数为 7.9 个，与转化组无统计学差异。腹腔镜组的平均住院时间（4.3 天）明显低于转化组。
腹腔镜已被证明是治疗 IGBC 的一种安全可行的方法。这种方法不仅可以进行完整的探查，识别以前未发现的残留肿瘤，还可以实现与开放手术相同的肿瘤学目标。因此，腹腔镜应被视为 IGBC 治疗的一种有效替代方法。
