Department of Surgical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands.
World J Surg Oncol. 2020 Apr 7;18(1):69. doi: 10.1186/s12957-020-01822-x.
Incidental gallbladder carcinoma is often discovered after elective laparoscopic cholecystectomy for cholecystitis or cholecystolithiasis. Port site recurrences may occur. Patients with port site metastases of gallbladder carcinoma have a poor prognosis.
A 61-year-old man underwent an elective laparoscopic cholecystectomy because of cholecystitis and gallstones. Pathology revealed a gallbladder carcinoma. After referral to a tertiary center, radical re-resection followed. Three years later, an epigastric port site recurrence emerged, partially fixed to the xiphoid process. A wide abdominal wall resection was performed, including part of the xiphoid process. Follow-up was continued with periodical imaging and standard blood work. Three years after resection of this port site metastasis, the patient presented with an occasionally painful mass in the left axilla. Pathology revealed the presence of an adenocarcinoma, most likely arising from the prior gallbladder carcinoma. Given the extensive dissemination and limited symptoms in the axillary node, we decided against a surgical intervention, instead of adopting a wait-and-see policy. Disease progression occurred within 1 year, and the patient was treated with palliative radiotherapy, followed by palliative chemotherapy. The patient died of metastatic disease approximately 6.5 years after the initial cholecystectomy.
Port site recurrences of (incidental) gallbladder carcinoma occur after laparoscopic cholecystectomy, despite preventive perioperative measures. Patients with port site recurrences can develop axillary lymph node metastases, similar to other truncal malignancies. Surgical interventions should be limited.
偶然发现的胆囊癌通常在因胆囊炎或胆囊结石行择期腹腔镜胆囊切除术（LC）后发现。可能会发生切口部位复发。患有胆囊癌切口部位转移的患者预后较差。
一名 61 岁男性因胆囊炎和胆囊结石行择期腹腔镜胆囊切除术。术后病理显示为胆囊癌。转至三级中心后，进行了根治性再切除术。3 年后，在上腹部切口部位出现复发，部分与剑突固定。进行了广泛的腹壁切除术，包括部分剑突。通过定期影像学和标准血液检查进行随访。在切除该切口部位转移后 3 年，患者出现左腋窝偶尔疼痛的肿块。病理显示存在腺癌，很可能来自先前的胆囊癌。鉴于腋窝淋巴结广泛播散且症状有限，我们决定不进行手术干预，而是采取观望策略。1 年内疾病进展，患者接受姑息性放疗，随后进行姑息性化疗。患者在初始胆囊切除术约 6.5 年后死于转移性疾病。
尽管采取了预防性围手术期措施，但（偶然）胆囊癌在 LC 后仍会发生切口部位复发。切口部位复发的患者可能会出现腋窝淋巴结转移，类似于其他躯干恶性肿瘤。手术干预应受限。
