Clinical Analysis of Unsuspected Gallbladder Cancer Diagnosed During or after Laparoscopic_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YAOChun-he ¹ ,  CHENChen ² , WANGLin ² , GENGZhi-min ²

1. 1.Department of Hepatobiliary Surgery, Xianyang Hospital of Yanan University, Xianyang 712000, Shaanxi Province, China;
2. 2.Department ofHepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China;

Corresponding?author：

CHENChen, Email: docchenchen@163.com

Keywords：

Unexpected gallbladder cancer; Laparoscopy; Prognosis; Two-stage surgery

DOI：

10.7507/1007-9424.20160194

Video：

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Objective To summarize the clinical characteristics of laparoscopic unexpected gallbladder cancer (UGC), and to explore the impact of TNM stage and secondary surgery timing on postoperative survival. Methods Clinical data of 70 UGC patients who treated in Xianyang Hospital of Yanan University and The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to January 2014 were retrospectively analyzed. The influencing of TNM staging and secondary surgery timing on the prognosis of UGC patients were analyzed by single factor analysis. Results Of the 70 patients before operation, 68 patients (97.2%) were diagnosed as calculus of gallbladder, 1 patient (1.4%) was diagnosed as gallbladder polyps, 1 patient (1.4%) was diagnosed as intrahepatic and extrahepatic bile duct stone. TNM staging: 2 patients (2.9%) in stage 0, 9 patients (12.9%) in stage Ⅰ, 50 patients (71.4%) in stage Ⅱ, 6 patients (8.6%) in stage Ⅲa, 1 patient (1.4%) in stage Ⅲb, 1 patient (1.4%) in stage Ⅳa, and 1 patient (1.4%) in stage Ⅳb. Fifty-five patients (78.6%) were confirmed by intraoperative frozen section examination, and 15 patients (21.4%) were confirmed after laparoscopic surgery. There were 66 patients were followed-up for 2-79 months, and the median follow-up time was 28-month, the 1-， 3-, and 5-year survival rates were 92.3%, 70.7%, and 53.7% respectively. The survival curves of stage 0, Ⅰ, Ⅱ, and Ⅲ+Ⅳ were differed significantly (P ＜0.01), the survival situation was best in patients in stage 0 and Ⅰ, but worst in patients in stage Ⅲ+Ⅳ. There was no statistical difference between the prognosis of patients underwent one-stage surgery and those underwent two-stage surgery (P=0.73). Conclusions A large proportion of UGC are in stage Ⅱ. For UGC patients, the prognosis is related with the clinical stage, so the surgical approach does not worsen the prognosis, regardless whether the tumor is detected during or after laparoscopic cholecystectomy.

Citation： YAOChun-he, CHENChen, WANGLin, GENGZhi-min. Clinical Analysis of Unsuspected Gallbladder Cancer Diagnosed During or after Laparoscopic. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 738-741. doi: 10.7507/1007-9424.20160194 Copy

1.	Dixon E, Vollmer CM Jr, Sahajpal A, et al. An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center. Ann Surg, 2005, 241(3): 385-394.
2.	Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA, 1983, 250(17): 2323-2326.
3.	O’Brien K, Cokkinides V, Jemal A, et al. Cancer statistics for Hispanics, 2003. CA Cancer J Clin, 2003, 53(4): 208-226.
4.	Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
5.	Lazcano-Ponce EC, Miquel JF, Mu?oz N, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin, 2001, 51(6): 349-364.
6.	Roa I, Ibacache G, Roa J, et al. Gallstones and gallbladder cancervolume and weight of gallstones are associated with gallbladder cancer: a case-control study. J Surg Oncol, 2006, 93(8): 624-628.
7.	陳志良, 任培土, 魯葆春, 等. 胃大部切除術后患者實施腹腔鏡膽囊切除和膽總管探查術的體會. 中華肝膽外科雜志, 2012, 18(6): 427-429.
8.	任培土, 魯葆春, 傅宏. 高齡膽囊癌48 例外科診治分析. 中華肝膽外科雜志, 2012, 18(4): 270-272.
9.	劉俊, 劉菊元, 晏俊, 等. 腹腔鏡膽囊切除術意外膽囊癌的診斷與治療: 附23 例報告. 中國普通外科雜志, 2012, 21(8): 985-988.
10.	Misra S, Chaturvedi A, Misra NC, et al. Carcinoma of the gallbladder. Lancet Oncol, 2003, 4(3): 167-176.
11.	Rammohan A, Cherukuri SD, Sathyanesan J, et al. Incidental gall bladder cancers: are they truly incidental?. World J Gastrointest Oncol, 2014, 6(12): 441-443.
12.	Pavlidis TE, Marakis GN, Ballas K, et al. Risk factors influencing conversion of laparoscopic to open cholecystectomy. J Laparoendosc Adv Surg Tech A, 2007, 17(4): 414-418.
13.	梅長青, 譚慧陵, 龔江波, 等. 腹腔鏡膽囊切除意外膽囊癌的處理. 中國普通外科雜志, 2011, 20(8): 893-894.
14.	Choi KS, Choi SB, Park P, et al. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: a systematic review and meta-analysis. W J Gastroenterol, 2015, 21(4): 1315-1323.
15.	Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: when, why and which reoperation?. J Visc Surg, 2011, 148(2): e77-e84.
16.	王志炎, 梁霄, 何石林, 等. 腹腔鏡膽囊切除術意外膽囊癌的治療. 中華醫學雜志, 2014, 94(40): 3159-3162.
17.	Goetze TO, Paolucci V. Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry. Surg Endosc, 2008, 22(11): 2462-2465.
18.	Cui HX, Ma XD, Han XL, et al. Surgical strategies for unexpected gallbladder carcinoma. Eur Rev Med Pharmacol Sci, 2014, 18(20): 3045-3047.
19.	Onoe S, Kaneoka Y, Maeda A, et al. Hepatectomy of segment 4b and 5 with extrahepatic bile duct resection for pT2 gallbladder carcinoma is valid: a single-institution result. Updates Surg, 2015, 67(3): 265-271.
20.	Clair DG, Lautz DB, Brooks DC. Rapid development of umbilical metastases after laparoscopic cholecystectomy for unsuspected gallbladder carcinoma. Surgery, 1993, 113(3): 355-358.
21.	Fong Y, Brennan MF, Turnbull A, et al. Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination. Arch Surg, 1993, 128(9): 1054-1056.
22.	Chan KM, Yeh TS, Jan YY, et al. Laparoscopic cholecystectomy for early gallbladder carcinoma: long-term outcome in comparison with conventional open cholecystectomy. Surg Endosc, 2006, 20(12): 1867-1871.
23.	Gourgiotis S, Kocher HM, Solaini L, et al. Gallbladder cancer. Am J Surg, 2008, 196(2): 252-264.
24.	Xu XQ, Liu W, Li BL, et al. Unsuspected gallbladder cancer during or after laparoscopic cholecystectomy. Chin Med Sci J, 2013, 28(2): 102-106.
25.	Shimizu T, Arima Y, Yokomuro S, et al. Incidental gallbladder cancer diagnosed during and after laparoscopic cholecystectomy. J Nippon Med Sch, 2006, 73(3): 136-140.
26.	Miller G, Jarnagin WR. Gallbladder carcinoma. Eur J Surg Oncol, 2008, 34(3): 306-312.
27.	孫學軍, 石景森, 王林, 等. 原發性膽囊癌診治分析( 附1 222 例報告). 中國實用外科雜志, 2014, 34(2): 179-182.
28.	Barakat J, Dunkelberg JC, Ma TY. Changing patterns of gallbladder carcinoma in New Mexico. Cancer, 2006, 106(2): 434-440.
29.	鄒聲泉, 張林.922 例膽囊癌相關危險因素的分析. 中華外科雜志, 2000, 38(11): 805-808.
30.	李靜靜, 劉衛, 曲強, 等. 膽囊癌患者151 例新版TNM 分期的臨床評估. 中華肝膽外科雜志, 2014, 20(7): 507-510.
31.	田遠虎, 楊廣運, 劉博, 等. 腹腔鏡膽囊切除術術中或術后發現意外膽囊癌的外科治療. 中華外科雜志, 2015, 53(2): 135-139.
32.	付振剛, 陳廣瑜, 成廣海, 等. 腹腔鏡膽囊切除中意外膽囊癌的處理( 附16 例報道). 中國普外基礎與臨床雜志, 2012, 19(2): 214-216.
33.	陸穎超, 顧玉青, 汪意青, 等. 意外膽囊癌的處理和分析( 附11 例報道). 中國普外基礎與臨床雜志, 2015, 22(5): 626-627.

1. Dixon E, Vollmer CM Jr, Sahajpal A, et al. An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center. Ann Surg, 2005, 241(3): 385-394.
2. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA, 1983, 250(17): 2323-2326.
3. O’Brien K, Cokkinides V, Jemal A, et al. Cancer statistics for Hispanics, 2003. CA Cancer J Clin, 2003, 53(4): 208-226.
4. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
5. Lazcano-Ponce EC, Miquel JF, Mu?oz N, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin, 2001, 51(6): 349-364.
6. Roa I, Ibacache G, Roa J, et al. Gallstones and gallbladder cancervolume and weight of gallstones are associated with gallbladder cancer: a case-control study. J Surg Oncol, 2006, 93(8): 624-628.
7. 陳志良, 任培土, 魯葆春, 等. 胃大部切除術后患者實施腹腔鏡膽囊切除和膽總管探查術的體會. 中華肝膽外科雜志, 2012, 18(6): 427-429.
8. 任培土, 魯葆春, 傅宏. 高齡膽囊癌48 例外科診治分析. 中華肝膽外科雜志, 2012, 18(4): 270-272.
9. 劉俊, 劉菊元, 晏俊, 等. 腹腔鏡膽囊切除術意外膽囊癌的診斷與治療: 附23 例報告. 中國普通外科雜志, 2012, 21(8): 985-988.
10. Misra S, Chaturvedi A, Misra NC, et al. Carcinoma of the gallbladder. Lancet Oncol, 2003, 4(3): 167-176.
11. Rammohan A, Cherukuri SD, Sathyanesan J, et al. Incidental gall bladder cancers: are they truly incidental?. World J Gastrointest Oncol, 2014, 6(12): 441-443.
12. Pavlidis TE, Marakis GN, Ballas K, et al. Risk factors influencing conversion of laparoscopic to open cholecystectomy. J Laparoendosc Adv Surg Tech A, 2007, 17(4): 414-418.
13. 梅長青, 譚慧陵, 龔江波, 等. 腹腔鏡膽囊切除意外膽囊癌的處理. 中國普通外科雜志, 2011, 20(8): 893-894.
14. Choi KS, Choi SB, Park P, et al. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: a systematic review and meta-analysis. W J Gastroenterol, 2015, 21(4): 1315-1323.
15. Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: when, why and which reoperation?. J Visc Surg, 2011, 148(2): e77-e84.
16. 王志炎, 梁霄, 何石林, 等. 腹腔鏡膽囊切除術意外膽囊癌的治療. 中華醫學雜志, 2014, 94(40): 3159-3162.
17. Goetze TO, Paolucci V. Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry. Surg Endosc, 2008, 22(11): 2462-2465.
18. Cui HX, Ma XD, Han XL, et al. Surgical strategies for unexpected gallbladder carcinoma. Eur Rev Med Pharmacol Sci, 2014, 18(20): 3045-3047.
19. Onoe S, Kaneoka Y, Maeda A, et al. Hepatectomy of segment 4b and 5 with extrahepatic bile duct resection for pT2 gallbladder carcinoma is valid: a single-institution result. Updates Surg, 2015, 67(3): 265-271.
20. Clair DG, Lautz DB, Brooks DC. Rapid development of umbilical metastases after laparoscopic cholecystectomy for unsuspected gallbladder carcinoma. Surgery, 1993, 113(3): 355-358.
21. Fong Y, Brennan MF, Turnbull A, et al. Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination. Arch Surg, 1993, 128(9): 1054-1056.
22. Chan KM, Yeh TS, Jan YY, et al. Laparoscopic cholecystectomy for early gallbladder carcinoma: long-term outcome in comparison with conventional open cholecystectomy. Surg Endosc, 2006, 20(12): 1867-1871.
23. Gourgiotis S, Kocher HM, Solaini L, et al. Gallbladder cancer. Am J Surg, 2008, 196(2): 252-264.
24. Xu XQ, Liu W, Li BL, et al. Unsuspected gallbladder cancer during or after laparoscopic cholecystectomy. Chin Med Sci J, 2013, 28(2): 102-106.
25. Shimizu T, Arima Y, Yokomuro S, et al. Incidental gallbladder cancer diagnosed during and after laparoscopic cholecystectomy. J Nippon Med Sch, 2006, 73(3): 136-140.
26. Miller G, Jarnagin WR. Gallbladder carcinoma. Eur J Surg Oncol, 2008, 34(3): 306-312.
27. 孫學軍, 石景森, 王林, 等. 原發性膽囊癌診治分析( 附1 222 例報告). 中國實用外科雜志, 2014, 34(2): 179-182.
28. Barakat J, Dunkelberg JC, Ma TY. Changing patterns of gallbladder carcinoma in New Mexico. Cancer, 2006, 106(2): 434-440.
29. 鄒聲泉, 張林.922 例膽囊癌相關危險因素的分析. 中華外科雜志, 2000, 38(11): 805-808.
30. 李靜靜, 劉衛, 曲強, 等. 膽囊癌患者151 例新版TNM 分期的臨床評估. 中華肝膽外科雜志, 2014, 20(7): 507-510.
31. 田遠虎, 楊廣運, 劉博, 等. 腹腔鏡膽囊切除術術中或術后發現意外膽囊癌的外科治療. 中華外科雜志, 2015, 53(2): 135-139.
32. 付振剛, 陳廣瑜, 成廣海, 等. 腹腔鏡膽囊切除中意外膽囊癌的處理( 附16 例報道). 中國普外基礎與臨床雜志, 2012, 19(2): 214-216.
33. 陸穎超, 顧玉青, 汪意青, 等. 意外膽囊癌的處理和分析( 附11 例報道). 中國普外基礎與臨床雜志, 2015, 22(5): 626-627.

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