Suzuki K, Kimura T, Ogawa H
First Department of Surgery, Hamamatsu University School of Medicine, Japan.
Surgery. 1998 Mar;123(3):311-4.
There have been several case reports of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC) being associated with fatal recurrence of cancer in the abdominal wall. Therefore there is a risk that LC might worsen the prognosis of gallbladder cancer. The objective of this study was to examine the frequency of recurrence of cancer in the abdominal wall and the prognosis of patients with unexpected gallbladder cancer diagnosed after LC.
A clinicopathologic study was performed on 30 patients with postoperatively diagnosed gall-bladder cancer among 3566 patients undergoing LC at 19 institutions. The cumulative survival rate was compared with that reported for gallbladder cancer diagnosed after open cholecystectomy.
Recurrence of cancer in the abdominal wall occurred in three patients, and two of them died. The 3-year survival rate was 100% for early gallbladder cancer and 70% for advanced tumors. These results were comparable to the 3-year survival rates for gallbladder cancer diagnosed after open cholecystectomy.
The incidence of recurrence of cancer in the abdominal wall was increased, but the medium-term prognosis was not worsened by laparoscopy. It does not appear necessary to exclude patients with cholecystitis or gallbladder wall hypertrophy from undergoing laparoscopic procedures on the grounds that they might have gallbladder cancer.
有几例关于腹腔镜胆囊切除术（LC）后诊断出意外胆囊癌并伴有腹壁致命性癌症复发的病例报告。因此，存在LC可能会恶化胆囊癌预后的风险。本研究的目的是检查腹壁癌症复发的频率以及LC后诊断出意外胆囊癌患者的预后情况。
对19家机构3566例行LC手术患者中的30例术后诊断为胆囊癌的患者进行了临床病理研究。将累积生存率与开腹胆囊切除术后诊断出的胆囊癌的报告生存率进行比较。
3例患者出现腹壁癌症复发，其中2例死亡。早期胆囊癌的3年生存率为100%，晚期肿瘤为70%。这些结果与开腹胆囊切除术后诊断出的胆囊癌的3年生存率相当。
腹壁癌症复发的发生率有所增加，但腹腔镜手术并未使中期预后恶化。似乎没有必要以可能患有胆囊癌为由，将胆囊炎或胆囊壁增厚的患者排除在腹腔镜手术之外。
