| Background This review aimed to compare laparoscopic with open resection of incidentally discovered gallbladder cancer while minimizing bias in selection.compared with the traditional open surgery and laparoscopic cholecystectomy has obvious advantages,such as shortening the length of stay,reducing postoperative pain,rapid recovery and so on.In recent decades,with the progress of endoscopic technology,laparoscopic cholecystectomy has gradually become the gold standard for the treatment of gallbladder benign diseases.The definition of Incidental gallbladder cancer(IGBC)is preoperative diagnosis of benign diseases,surgical treatment,pathological confirmation of gallbladder cancer.IGBC is relatively rare in clinic and about half of the patients have no obvious clinical manifestations.A few patients may have symptoms and signs similar to cholelithiasis without specificity.The first symptom was acute cholecystitis.The cause of gallbladder cancer is not clear,which may be related to chronic inflammation of gallbladder wall mucosa.Objective:The main objective of this study is to investigate the diagnosis and Treatment of incidental Gallbladder cancer,to improve the early diagnosis of gallbladder cancer And Improve the understanding of the Disease.Method Review clinical data analysis of 77 IGBC Incidental gallbladder cancer patients in the Department of General Surgery,Sir Run Run Shaw Clinic,College of Medicine,Zhejiang University Analysis of clinical and pathological reports on laparoscopic and open surgery.From 2011To 2019.The primary outcome was relapse time and death date.Secondary outcome indicators included 90-day mortality,complications number of lymph nodes preserved and patterns of recurrence.Incidental gallbladder cancer was defined in the final pathology report after open or laparoscopic cholecystectomy for suspected benign disease as cancer.Major resection was known as liver resection,including three or more segments of liver.Bile spillage information was not consistently available,as almost all patients had index operation at an outside institution.Results Result Of 77 patients with GBC,)underwent laparoscopic group LC/LRC(n=32.16 of whom underwent laparoscopic cholecystectomy,and the others underwent laparoscopic radical cholecystectomy/extended radical cholecystectomy,RC(n=45)patients underwent radical cholecystectomy/extended radical cholecystectomy.There were no perioperative deaths.There was no significant difference in the LC/LRC(n=32)+RC(n=45):P-value between the laparoscopic group and the laparotomy group.Duration of surgery(IQR),min(P<0.001),Estimated blood loss(IQR),ml(P<0.001),Hospital stay(IQR),days(P=0.002)in the laparoscopic group were all earlier than those in the laparotomy group,and the difference was statistically significant.multivariate analyses of various prognostic parameters in patients with gallbladder cancer survival period Cox-regression analysis Gender(P=0.036)Laparoscopic and open(P=0.04),perineural invasion(P=0.034),TNM staging(P=0.012),multivariate analyses of various prognostic parameters in patients with gallbladder cancer survival period Cox-regression analysis.Gender(P=0.047),Age(P=0.029),Intraoperative frozen????(P=0.043),perineural invasion????(P=0.018),Vascular invasion????(P=0.015),L+(P=0.016).The following data were collected:re-resection surgical approach(open or laparoscopic);demographic and clinical baseline characteristics;details of clinicopathological findings and use of open surgery at initial Cholecystectomy;disease management,clinicopathological findings,duration of hospital stay,blood loss and postoperative complications at the time of second radical resection;and location.In the intention-to-treat analysis,all patients whose surgery was initiated with a laparoscopic approach were included in the laparoscopic re-resection group even when conversion to open surgery occurred.The different pathologic T stages,the 5-y survival rates of patients with stage Tis(7cases),T1(9 cases),T2(55 cases),and T3(6 cases)CONCLUSION:This study validates the concept of re-resection in T2 and T3 GBC.Bile duct resection increases postoperative morbidity but does not improve survival.There is currently a modification in the surgical management of incidental GBC,with minor liver resection and no common bile duct resection.incidental of accidental gallbladder cancer is common in middle-aged and elderly women.With the number of laparoscopic cholecystectomy increasing year by year,the incidence rate is gradually increasing.2.Most of the patients have normal liver function.Most of the patients have no obvious abnormalities in serum tumor markers.3.Before laparoscopic cholecystectomy,if the abdominal ultrasound is abnormal,CT and MRI are necessary.Further definite diagnosis;4.Preventive cholecystectomy is recommended for single stone with diameter more than 3cm,multiple stone,full stone,congenital abnormality at the junction of biliopancreatic duct,calcification of gallbladder mucosa and symptomatic gallbladder polyp or combined with gallstone,or asymptomatic polyp with diameter between5mm-10mm.5.Radical cholecystectomy As the first choice of treatment,it can improve the prognosis. |
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