Incidental Gallbladder Cancer Diagnosed During or After Laparoscopic Cholecystectomy, What Did We Do ?

Yıl 2020, Cilt: 12 Sayı: 3, 546 - 550, 20.10.2020

Ali Sapmaz , Cem Güldoğan , Betül Keskinkılıç , Ahmet Karaca

https://doi.org/10.18521/ktd.747234

Öz

Objective: Gallbladder cancer is a rare neoplasm. We report our experience with gallbladder cancer that was incidentally diagnosed during or after laparoscopic cholecystectomy performed for gallstone disease.

Method: This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from January 2010 to April 2015. Exclusion criteria were suspicion of malignancy and/or existence of gallbladder polyps detected with ultrasonography preoperatively. Patients with incidentally diagnosed gallbladder cancer were recorded, and the clinical and demographic characteristics of these patients were reviewed.

Results: Of 6,114 patients in whom laparoscopic cholecystectomy was attempted, 5,948 were included in this study. Incidental gallbladder cancer was found in thirty-six patients, with a mean age of 64.08 years. The histological tumor stages were adenocarcinoma in situ in seven patient, pT1b in nine patient, pT2 in eleven patient, and pT3 in nine patients. Sixteen patients who underwent laparoscopic cholecystectomy alone underwent no additional surgery because of the low stage of the tumors. The twenty remaining patients, whose laparoscopic cholecystectomies were converted to open surgeries, underwent cholecystectomy, excision of the liver bed and lymph node dissection. The overall median survival time was 28 months.

Conclusion: The incidence of incidental gallbladder cancer has been reported to vary, up to 2.85%. In this single-center study, the rate of incidental gallbladder cancer was found to be 0.60%. Female gender and advanced age are demographic risk factors for gallbladder carcinoma. Although gallbladder cancer is well known for its poor prognosis, tumors that are incidentally diagnosed are often found at an early stage and have a better prognosis.

Anahtar Kelimeler

CHOLECYSTECTOMY, GALLBLADDER CANCER, incidence, Laparoscopy, Prognosis

Laparoskopik Kolesistektomi Sırasında veya Sonrasında Teşhis Edilen İncidental Safra Kesesi Kanseri. Biz ne Yaptık?

Öz

Amaç: Safra kesesi kanseri nadir görülen bir neoplazmdır. Kolelitiazis nedeni ile yapılan laparoskopik kolesistektomi sırasında veya sonrasında tesadüfen teşhis edilen safra kesesi kanseri ile ilgili deneyimlerimizi sunuyoruz.

Metod: Bu çalışma, Ocak 2010'dan Nisan 2015'e kadar yapılan kolelitiazis e bağlı tüm laparoskopik kolesistektomileri içermiştir. Çalışmada dışlama kriterleri; ameliyat öncesi ultrasonografi ile tespit edilen malignite şüphesi ve / veya safra kesesi poliplerinin varlığıydı. Safra kesesi kanseri tanısı konan hastalar incelendi ve bu hastaların klinik ve demografik özellikleri gözden geçirildi.

Bulgular: Laparoskopik kolesistektomi yapılan 6,114 hastadan 5,948'i çalışmaya dahil edildi. Yaş ortalaması 64,08 olan otuzaltı hastada rastlantısal safra kesesi kanseri saptandı. Histolojik tümör evreleri yedi hastada in situ adenokarsinom, dokuz hastada pT1b, onbir hastada pT2 ve dokuz hastada pT3 idi. Sadece laparoskopik kolesistektomi yapılan 16 hastaya tümörlerin düşük evresi nedeniyle ek cerrahi uygulanmadı. Laparoskopik kolesistektomileri açık ameliyatlara dönüştürülen kalan 20 hastaya kolesistektomi, karaciğer yatağı eksizyonu ve lenf nodu diseksiyonu uygulandı. Genel ortalama sağkalım süresi 28 aydı.

Sonuç: İnsidental safra kesesi kanseri insidansının % 2,85'e kadar olabildiği bildirilmiştir. Bu tek merkezli çalışmada, rastlantısal safra kesesi kanseri oranı % 0,60 olarak bulunmuştur. Kadın cinsiyet ve ileri yaş safra kesesi karsinomu için demografik risk faktörleridir. Safra kesesi kanseri kötü prognozu ile iyi bilinmesine rağmen, tesadüfen teşhis edilen tümörler sıklıkla erken bir aşamada bulunur ve daha iyi bir prognoza sahiptir.

Anahtar Kelimeler

Kolesistektomi, Safra kesesi karsinomu, İnsidans, Laparoskopi, Prognoz

Kaynakça

• 1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56: 106-30. 2. Frauenshuh D, Greim R, Kraas E. How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy. Langenbecks Arch Surg 2000; 385: 495-500. 3. Sarli L, Contini S, Sansebastiano G, et al. Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer? Arch Surg 2000; 135: 1340-4. 4. Antonakis P, Alexakis N, Mylonaki D, et al. Incidental finding of gallbladder carcinoma detected during or after laparoscopic cholecystectomy. Eur J Surg Oncol 2003; 29: 358-60. 5. Yamamoto H, Hayakawa N, Kitagawa Y, et al. Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 2005; 12: 391-8. 6. Shimizu T, Arima Y, Yokomuro S, et al. Incidental gallbladder cancer diagnosed during and after laparoscopic cholecystectomy. J Nippon Med Sch 2006; 73: 136-40. 7. Kwon AH, Imamura A, Kitade H, Kamiyama Y. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 2008; 97: 241-5. 8. Tantia O, Jain M, Khanna S, Sen B. Incidental carcinoma gall bladder during laparoscopic cholecystectomy for symptomatic gall stone disease. Surg Endosc 2009; 23: 2041-6. 9. Choi SB, Han HJ, Kim CY, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 2009; 33: 2657-63. 10. Zhang WJ, Xu GF, Zou XP, et al. Incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy. World J Surg 2009; 33: 2651-6. 11. Mori T, Souda S, Hashimoto J, et al. Unsuspected gallbladder cancer diagnosed by laparoscopic cholecystectomy: a clinicopathological study. Surg Today 1997; 27: 710-3. 12. Edge SB, Byrd DR, Compton CC, et al., eds. AJCC cancer staging manual. 7th ed. New York: Springer, 2010; 347-77. 13. Goldin R, Roa J. Gallbladder cancer: a morphological and molecular update. Histology 2009; 58: 218-29. 14. Steinert R, Nestler G, Sagynaliev E, et al. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 2006; 93: 682-9. 15. Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA. Gallbladder carcinoma update: multimodality imaging evaluation, staging, and treatment options. AJR Am J Roentgenol 2008; 191: 1440-7. 16. Yamaguchi K, Chijiiwa K, Saiki S, et al. Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 1997; 84: 200-4. 17. Yildirim E, Celen O, Gulben K, Berberoglu U. The surgical management of incidental gallbladder carcinoma. Eur J Surg Oncol 2005; 31: 45-52. 18. You DD, Lee HG, Paik KY, et al. What is an adequate extent of resection for T1 gallbladder cancers? Ann Surg 2008; 247: 835-8. 19. Wakai T, Shirai Y, Yokoyama N, et al. Early gallbladder carcinoma does not warrant radical resection. Br J Surg 2001; 88: 675-8. 20. Principe A, Del Gaudio M, Ercolani G, et al. Radical surgery for gallbladder carcinoma: possibilities of survival. Hepatogastroenterology 2006; 53: 660. 21. Puhalla H, Wild T, Bareck E, et al. Long-term follow-up of surgically treated gallbladder cancer patients -4. Eur J Surg Oncol 2002; 28: 857-63. 22. Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French surgical association survey. Ann Surg 1994; 219: 275-80. 23. Varshney S, Buttirini G, Gupta R. Incidental carcinoma of the gallbladder. Eur J Surg Oncol 2002; 28: 4-10.