| Background Laparoscopic cholecystectomy has obvious advantages over conventional laparotomy,such as shorter hospital stay,slight postoperative pain,and rapid recovery.In recent decades,accompanied by the progress of laparoscopic technology,laparoscopic cholecystectomy has been the gold standard for the treatment of benign gallbladder diseases.The definition of "incidental gallbladder cancer(IGBC)" is that gallbladder cancer is pathologically confirmed but it is preoperatively diagnosed as a benign disease.IGBC is rare in clinical practice.About half of patients have no special clinical manifestations.A small number of patients may have symptoms and signs that similar to cholelithiasis without specificity.Very few patients have the first symptoms of acute cholecystitis.The cause of gallbladder cancer is not yet clear,and may be related to the long-term chronic inflammation of the gallbladder mucosa.This study retrospectively analyze the clinical manifestations,preoperative examinations,intraoperative frozen section examination,surgical methods,and postoperative routine pathology in the 21 cases of incidental gallbladder cancer admitted to the hospital where the author is admitted.Objective The purpose of this study is to investigate the diagnosis and treatment of incidental gallbladder cancer,so as to improve the early diagnosis of gallbladder cancer,and improve the understanding of the disease.Method The clinical data of 2862 cases undergoing laparoscopic cholecystectomy performed at the Qilu Hospital of Shandong University from January 2013 to December 2017 is retrospectively analyzed.And the the correlation clinical data of the 21 cases diagnosed as gallbladder cancer by intraoperative frozen section examination or postoperative pathology were screened out for further research and analysis.Result This study retrospectively analyzed from January 2013 to December 2017,a total of 2862 patients who had been treated with "laparoscopic cholecystectomy" for"benign gallbladder disease" at the Qilu Hospital of Shandong University,including 1221 male patients and 1641 female patients.The male-female ratio is 1:1.34.21 patients diagnosed as incidental gallbladder cancer were included,of which 17 cases were confirmed by intraoperative frozen section examination.The remaining 4 cases were confirmed by routine pathology after surgery.The incidence of incidental gallbladder cancer was 0.7%,of which 7 were male and 14 were female,with a male-female ratio of 1:2.The average age of the patients is 67.6(45-87 years old).The clinical manifestations of patients diagnosed incidental gallbladder cancer were not significantly different from those of benign diseases,such as gallstones or gallbladder polyps.Eight patients showed pain in the right upper quadrant.Eleven patients had no obvious clinical symptoms,and two patients showed abdominal distension.Preoperative liver function grade was grade A in all studied patients.Among the patients,17 patients underwent serum oncology tests for carbohydrate chain antigen(CA)19-9,of which 4 were elevated.There were 17 patients underwent carcinoembryonic antigen(CEA)examination,and 2 of them were elevated.Seventeen patients were examined for serum alpha-fetoprotein(AFP)levels and one of them was elevated.Sixteen patients were examined for the serum tumor marker sugar chain antigen(CA)125,of which 2 were elevated.Eight patients underwent the examination of the serum tumor marker sugar chain antigen(CA)724.The results were within the normal range.There were 16 patients underwent preoperative abdominal ultrasound examination.Eight cases were showed cholecystitis and gallbladder stones and 2 of them were also associated with localized thickening of the gallbladder wall and 1 of them was accompanied by adenoma,and 1 case was accompanied with gallbladder atrophy by ultrasonography.Two cases were showed gallbladder adenoma by ultrasonography.Three cases were showed simple localized thickening of the gallbladder wall by ultrasonography.Two cases were showed solid nodules in the gallbladder cavity by ultrasonography.One case showed polyps in the gallbladder cavity.Nineteen patients underwent preoperative CT examination.Among them,9 cases of CT showed gallbladder stones with cholecystitis,of which 3 cases were accompanied by polyps or adenomas,1 case was also accompanied with limitations of the gallbladder wall thickening.Four cases were showed gallbladder polyps by CT.Two cases were showed gallbladder adenoma by CT.Two cases were showed gallbladder wall thickening by CT.One case was showed Xanthogranulomatous cholecystitis by CT.One case was showed gallbladder adenomyosis by CT.There were 2 patients with a history of gallstone more than one decade.The surgical approach of 21 cases showed that there were 16 patients only underwent laparoscopic cholecystectomy,including 1 patient had severe abdominal adhesions and had undergone laparotomy for cholecystectomy.There were 2 patients underwent laparoscopic cholecystectomy plus peripheral lymph node dissection and liver IVb and V segment resection.There were 2 patients underwent laparoscopic cholecystectomy plus Glisson sheath lymph node dissection.According to the seventh edition of the American Joint Committee on Cancer(AJCC),postoperative T staging of tumors were as follows:pTis(3 cases),pTlb(4 cases),pT2(3 cases),pT3(11 cases).Three cases of anatomical stage were 0(TisNOMO);4 cases of anatomical stage were I(T1N0M0);3 cases of anatomical stage were ?(T3N0M0);10 cases of anatomical stage were IIIA(T3N0M0);1 case of anatomical stage was IIIB(T1-3 N1M0).The early incidental gallbladder cancers accounted for 47.6%.In the follow-up we find that radical surgery can achieve better prognosis.Conclusion The incidence of accidental gallbladder cancer tends to occur in middle-aged and old women.The incidence rate gradually increases as the number of laparoscopic cholecystectomy increases year by year.2.The liver function is normal in most of the patients.Besides the serum tumor markers of most patients are within normal range.3.Before routine laparoscopic cholecystectomy,if the abdominal ultrasound shows abnormalities,CT and MRI are necessary for further diagnosis.4.The patients shoud be recommended for preventive cholecystectomy if they present the following signs:single gallstones in the gallbladder more than 3 cm,multiple stones,full stones,congenital anomalies at the confluence of biliary and pancreatic ducts,gallbladder mucosal calcification,and symptomatic gallbladder polyps,or accompanied with gallbladder stones,or between 5mm and 10mm in diameter symptomatic polyps.5.Radical excision should be the first choice for treatment to ensure a better prognosis. |
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