Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata, 951-8566, Japan.
Langenbecks Arch Surg. 2021 Aug;406(5):1521-1532. doi: 10.1007/s00423-021-02165-1. Epub 2021 Apr 10.
This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC).
Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3).
Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024).
The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.
本研究旨在阐明初始胆囊切除术后残留疾病（RD）的解剖位置对意外胆囊癌（IGBC）再次切除后生存的影响。
分析了接受切除术的 pT2 或 pT3 胆囊癌（36 例 IGBC 和 171 例非 IGBC）患者。根据初始胆囊切除术后 RD 的解剖位置，将 IGBC 患者分为以下几类：无 RD（第 1 组）；RD 位于胆囊床、胆囊管残端和/或区域淋巴结（第 2 组）；RD 位于肝外胆管和/或远处部位（第 3 组）。
在多变量或倾向评分匹配分析中，切除时机（IGBC 与非 IGBC）均未影响生存。36 例 IGBC 患者中有 16 例（44.4%）发现 RD；32 例（88.9%）患者在再次切除后达到了 R0 切除。再次切除后，第 3 组（n = 7；5 年 OS，14.3%）的总体生存率（OS）明显差于第 2 组（n = 9；5 年 OS，55.6%）（p = 0.035）或第 1 组（n = 20；5 年 OS，88.7%）（p < 0.001）。第 1 组和第 2 组之间的生存差异无统计学意义（p = 0.256）。RD 的解剖位置与 OS 独立相关（第 2 组，HR 2.425，p = 0.223；第 3 组，HR 9.627，p = 0.024）。
RD 的解剖位置独立预测再次切除后的生存情况，这对 IGBC 的局部区域疾病控制有效，与非 IGBC 的切除效果相似。并非所有 RD 患者在再次切除 IGBC 后生存情况均较差。
