Blakely Andrew M, Wong Paul, Chu Peiguo, Warner Susanne G, Raoof Mustafa, Singh Gagandeep, Fong Yuman, Melstrom Laleh G
Department of Surgery, City of Hope National Medical Center, Duarte, California.
Department of Pathology, City of Hope National Medical Center, Duarte, California.
J Surg Oncol. 2019 Sep;120(4):603-610. doi: 10.1002/jso.25617. Epub 2019 Jul 10.
Gallbladder adenocarcinoma is often incidentally identified following cholecystectomy. We hypothesized that intraoperative bile spillage would be a negative prognostic factor.
A retrospective review of patients treated at a cancer center with histologically confirmed gallbladder adenocarcinoma, 2009-2017, was performed. Patient, disease, and treatment factors were analyzed in terms of progression-free survival (PFS) and overall survival (OS).
Sixty-six patients were identified. Tumor stage was T1 (n = 8, 12%), T2 (n = 23, 35%), T3 (n = 35, 53%). Node stage was N0 (n = 22, 33%), N1+ (n = 26, 39%), Nx (n = 18, 27%). Operations included cholecystectomy alone (n = 27, 36%), cholecystectomy and partial hepatectomy (n = 30, 45%), or hepaticojejunostomy (n = 9, 14%). Median PFS was 7 months (interquartile range [IQR], 2-19); median OS was 16 months (IQR, 10-31). Subset multivariate proportional hazards regression of 41 patients who underwent initial cholecystectomy showed decreased PFS was associated with intraoperative spillage (n = 12, 29%; hazard ratio [HR], 5.5; P = .0014); decreased OS was associated with drain placement (n = 21, 51%; HR, 8.1; P = .006).
Intraoperative bile spillage and surgical drain placement at initial cholecystectomy are negatively associated with PFS and OS in gallbladder adenocarcinoma. Explicit documentation of spillage and drain placement rationale is critical, possibly indicating locally advanced disease and prompting stronger consideration of systemic therapy before definitive resection.
胆囊腺癌常在胆囊切除术后偶然发现。我们推测术中胆汁外溢是一个不良预后因素。
对2009年至2017年在一家癌症中心接受组织学确诊的胆囊腺癌患者进行回顾性研究。从无进展生存期（PFS）和总生存期（OS）方面分析患者、疾病和治疗因素。
共纳入66例患者。肿瘤分期为T1期（n = 8，12%）、T2期（n = 23，35%）、T3期（n = 35，53%）。淋巴结分期为N0期（n = 22，33%）、N1+期（n = 26，39%）、Nx期（n = 18，27%）。手术方式包括单纯胆囊切除术（n = 27，36%）、胆囊切除术加部分肝切除术（n = 30，45%）或肝空肠吻合术（n = 9，14%）。PFS中位数为7个月（四分位间距[IQR]，2 - 19）；OS中位数为16个月（IQR，10 - 31）。对41例行初次胆囊切除术的患者进行亚组多因素比例风险回归分析显示，PFS降低与术中胆汁外溢有关（n = 12，29%；风险比[HR]，5.5；P = 0.0014）；OS降低与放置引流管有关（n = 21，51%；HR，8.1；P = 0.006）。
初次胆囊切除术中的术中胆汁外溢和放置手术引流管与胆囊腺癌的PFS和OS呈负相关。明确记录胆汁外溢情况和引流管放置理由至关重要，这可能提示局部晚期疾病，并促使在确定性切除术前更强烈地考虑全身治疗。
