Ali, Cem Emir GÜLDOĞAN, Betül YAĞIZ, Ahmet Serdar KARACA

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

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

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

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.

Keywords:

CHOLECYSTECTOMY, GALLBLADDER CANCER, incidence, Laparoscopy, Prognosis,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez