Department of Surgery, Sada Hospital, Fukuoka, Japan.
PLoS One. 2020 Sep 18;15(9):e0239178. doi: 10.1371/journal.pone.0239178. eCollection 2020.
Unexpected gallbladder cancer (UGBC) is sometimes found in the resected gallbladder of patients during or after surgery. Some reports have indicated UGBC identification rates for all gallbladder surgeries, but scarce data are available for the UGBC identification rates for specific gallbladder diseases. The present study was performed to clarify UGBC rates and the factors suspicious for UGBC categorized according to preoperative diagnoses, in patients undergoing laparoscopic cholecystectomy (LSC).
We recorded data for all LSC surgeries performed in the Department of Surgery, Sada Hospital, Japan since 1991, and analyzed the 28-year data. We used the chi-square test and Kaplan-Meier analysis for this retrospective case-control study.
The UGBC identification rate was 0.69% (63/9186 patients). The UGBC identification rates categorized according to the preoperative diagnoses were 1.3% (13/969) for acute cholecystitis, 2.4% (16/655) for benign tumor, 2.0% (28/1383) for chronic cholecystitis or cholecystitis, and 0.054% (3/5585) for cholecystolithiasis. The percentage of older patients (≥ 60 years) was significantly higher in UGBCs compared with cases finally diagnosed as benign in each group categorized according to the preoperative diagnoses (p≤0.0014), except for cholecystolithiasis. In cases pre-diagnosed as benign tumor, UGBCs were associated with higher rates of thickened gallbladder wall compared with benign tumor (69.2% vs. 27.9%, respectively; p = 0.0011). UGBCs pre-diagnosed as acute cholecystitis had higher T2-T4 rates (100% vs. 64.3%, respectively; p<0.05) and lower survival rates (p = 0.0149) than UGBCs pre-diagnosed with chronic cholecystitis.
UGBC identification rates depend on the preoperative diagnosis and range from 0.054% to 2.4%. Older age (≥ 60 years) could be related to UGBC, and a pre-diagnosis of acute cholecystitis might indicate more advanced cancer compared with a pre-diagnosis of chronic cholecystitis.
在手术过程中或手术后，有时会在切除的胆囊中发现意外的胆囊癌（UGBC）。一些报告指出了所有胆囊手术的 UGBC 检出率，但对于特定胆囊疾病的 UGBC 检出率，数据却很少。本研究旨在明确腹腔镜胆囊切除术（LSC）患者中，根据术前诊断分类的 UGBC 发生率和可疑 UGBC 因素。
我们记录了自 1991 年以来在日本佐田医院外科进行的所有 LSC 手术的数据，并对这 28 年的数据进行了分析。我们对这项回顾性病例对照研究使用了卡方检验和 Kaplan-Meier 分析。
UGBC 的检出率为 0.69%（63/9186 例）。根据术前诊断分类的 UGBC 检出率为：急性胆囊炎 1.3%（13/969），良性肿瘤 2.4%（16/655），慢性胆囊炎或胆囊炎 2.0%（28/1383），胆囊结石 0.054%（3/5585）。与每个根据术前诊断分类的最终诊断为良性的病例相比，UGBC 中年龄较大（≥60 岁）的患者比例显著更高（p≤0.0014），除了胆囊结石。在术前诊断为良性肿瘤的病例中，UGBC 与良性肿瘤相比，胆囊壁增厚的发生率更高（分别为 69.2%和 27.9%；p=0.0011）。术前诊断为急性胆囊炎的 UGBC 患者 T2-T4 分期更高（100%比 64.3%；p<0.05），生存率更低（p=0.0149），而术前诊断为慢性胆囊炎的 UGBC 患者则更低。
UGBC 的检出率取决于术前诊断，范围在 0.054%至 2.4%之间。年龄较大（≥60 岁）可能与 UGBC 有关，与慢性胆囊炎相比，急性胆囊炎的术前诊断可能提示更晚期的癌症。
