Haldeniya Kulbhushan, Singh Ashish, Bhatt Neha, Mishra Prabhakar, Singh Rajneesh Kumar, Saxena Rajan
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Ann Hepatobiliary Pancreat Surg. 2021 Nov 30;25(4):492-499. doi: 10.14701/ahbps.2021.25.4.492.
BACKGROUNDS/AIMS: Re-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus.
A retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC.
Twenty-two patients in 'E', 48 in 'I', and 21 in 'L' groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the 'L' group (30.8%) than in the 'I' (11.1%) or 'E' (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the 'L' group could undergo curative resection (R0/R1 resection), significantly less than that in the 'E' (50.0%) or 'I' group (64.6%) (both < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection ( < 0.05).
Asymptomatic patients in the 'I' group with well differentiated IGBC have the best chance of obtaining a curative resection.
背景/目的：部分偶然发现的胆囊癌（IGBC）患者有可能进行再次切除。然而，再次干预的最佳时机尚无共识。
对2009年至2018年管理的91例IGBC患者的前瞻性数据库进行回顾性分析。根据初次胆囊切除术与再次手术或最终分期之间的持续时间，将患者分为三组：早期（E），<4周；中期（I），>4周且<12周；晚期（L），>12周。分析患者的人口统计学数据、肿瘤特征和手术细节，以确定影响IGBC再次切除可能性的因素。
“E”组22例、“I”组48例和“L”组21例患者匹配良好。近三分之二的患者无症状。48例（52.7%）患者可行根治性切除。26例（28.6%）患者在分期腹腔镜检查（SL）/剖腹手术中发现转移。“L”组SL的检出率（30.8%）高于“I”组（11.1%）或“E”组（无），避免了13.6%的不必要剖腹手术。“L”组只有28.5%的患者能够接受根治性切除（R0/R1切除），显著低于“E”组（50.0%）或“I”组（64.6%）（均<0.001）。多因素分析显示，中期出现和肿瘤分化增加了根治性切除的机会（<0.05）。
“I”组无症状且IGBC分化良好的患者获得根治性切除的机会最大。
