Incidental gallbladder cancer during laparoscopic cholecystectomy:Managing an unexpected finding

作     者：Andrea Cavallaro Gaetano Piccolo Vincenzo Panebianco Emanuele Lo Menzo Massimiliano Berretta Antonio Zanghì Maria Di Vita Alessandro Cappellani 

作者机构：Department of SurgeryGeneral Surgery and Breast UnitUniversity of CataniaVia S.Sofia 7895123 CataniaItaly Department of SurgeryGeneral Surgery Unit of Taormina Hospital "San Vincenzo"98039 MessinaItaly Division of Laparoscopic and Bariatric SurgeryUniversity of MarylandBaltimoreMD 21201United States Department of Medical OncologyNational Cancer Institute-IRCCS33081 AvianoItaly 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第30期

页      面：4019-4027页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：切除术 腹腔镜 胆囊 病理诊断 手术治疗 管理 癌 冰冻切片 

摘      要：AIM:To evaluate the impact of incidental gallbladder cancer on surgical ***:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively *** pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and *** GBC was compared with suspected or preoperatively diagnosed *** primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first ***:Nineteen patients(11 women and eight men) were found to have *** male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed *** was suspected intraoperatively and confirmed by frozen *** ratio between incidental and nonincidental cases was 9/*** tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasi