Coimbra Felipe Jose F, Torres Orlando Jorge M, Alikhanov Ruslan, Agarwal Anil, Pessaux Patrick, Fernandes Eduardo de Souza M, Quireze-Junior Claudemiro, Araujo Raphael Leonardo C, Godoy André Luis, Waechter Fabio Luis, Resende Alexandre Prado de, Boff Marcio Fernando, Coelho Gustavo Rego, Rezende Marcelo Bruno de, Linhares Marcelo Moura, Belotto Marcos, Moraes-Junior Jose Maria A, Amaral Paulo Cezar G, Pinto Rinaldo Danesi, Genzini Tercio, Lima Agnaldo Soares, Ribeiro Heber Salvador C, Ramos Eduardo José, Anghinoni Marciano, Pereira Lucio Lucas, Enne Marcelo, Sampaio Adriano, Montagnini André Luis, Diniz Alessandro, Jesus Victor Hugo Fonseca de, Sirohi Bhawna, Shrikhande Shailesh V, Peixoto Renata D Alpino, Kalil Antonio Nocchi, Jarufe Nicolas, Smith Martin, Herman Paulo
Department of Gastrointestinal Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
Department of Hepatopancreatobiliary Surgery, Federal University of Maranhão, São Luis, Brazil.
Arq Bras Cir Dig. 2020 Jul 8;33(1):e1496. doi: 10.1590/0102-672020190001e1496.
Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis.
To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil.
Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment.
Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely.
It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.
意外胆囊癌是指在胆囊切除术后经组织学检查发现的癌症。它是一种潜在可治愈的疾病。然而，一些与治疗相关的问题仍存在争议，明确的治疗策略与更好的预后相关。
制定巴西意外胆囊癌患者治疗的首个循证共识。
选取16个问题，36名巴西和国际成员参与回答。这些陈述基于当前的循证文献。最终报告发送给专家组成员进行一致性评估。
建议对标本进行术中评估、使用取物袋和进行常规组织病理学检查。术前需进行全面评估，一旦获得最终分期，应进行再次手术。建议评估胆囊管切缘并常规进行16b1淋巴结活检。应考虑化疗，若手术切缘镜下阳性则考虑放化疗。仅在特殊情况下切除手术切口部位。建议在再次手术前行分期腹腔镜检查，但仅在专业的微创肝胰胆中心采用微创根治性手术。如果实现R0切除，则肝切除范围是可接受的。对于T2及以上肿瘤，需要进行标准淋巴结清扫，但不建议常规进行胆总管切除。
有可能制定安全的建议，作为意外胆囊癌治疗的指导，涉及消化外科和普通外科日常工作中最常见的问题。
