Abstract: Objective:To analyze the pathological results and current treatment situation of patients with unexpected gallbladder carcinoma from multi-centers in China, and explore the diagnosis and treatment of unexpected gallbladder carcinoma.
Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 223 patients with unexpected gallbladder carcinoma who were admitted to the 8 clinical centers from January 2010 to December 2016 were collected, including 86 in the First Affiliated Hospital of Xi′an Jiaotong University, 41 in the First Affiliated Hospital of Zhengzhou University, 30 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, 27 in the Xinhua Hospital of Shanghai Jiaotong University, 13 in the First Affiliated Hospital of Dalian Medical University, 11 in the Tianjin Medical University Cancer Institute & Hospital, 9 in the First Affiliated Hospital of Army Medical University (Third Military Medical University) and 6 in the Affiliated Hospital of North Sichuan Medical College. Treatment of patients with unexpected gallbladder carcinoma who were diagnosed by intraoperative frozen section biopsy and postoperative pathological examination followed guideline for the diagnosis and treatment of gallbladder carcinoma (2015 edition). According to tumor staging and patients′ decision, postoperative adjuvant treatment was selectively performed. Observation indicators: (1) diagnosis and treatment of unexpected gallbladder carcinoma; (2) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to June 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). The survival time was calculated using the Kaplan-Meier method.
Results:(1) Diagnosis and treatment of unexpected gallbladder carcinoma: of 223 patients with unexpected gallbladder carcinoma, 80 were initially diagnosed using intraoperative frozen section biopsy ［20 received T stage results (intraoperative T stage of 14 patients had not matched postoperative results), and 60 didn′t receive T stage results］, and 143 were initially diagnosed using postoperative pathological examination (13 were initially diagnosed with gallbladder benign disease by intraoperative frozen section biopsy and 130 didn′t intraoperatively receive frozen section biopsy). Of 223 patients , 209, 10, 3 and 1 were respectively confirmed as adenocarcinoma, adenoma canceration, neuroendocrine tumor and squamous cell carcinoma; 6, 16, 32, 73, 75, 12 and 9 were respectively detected in Tis, T1a, T1b, T2, T3 and T4 stages and undefined stage; 140 underwent reoperations, including 106 with radical resection of gallbladder carcinoma and 34 with extended radical resection of gallbladder carcinoma; operation of 126 patients reached the standard and operation of 97 patients didn′t reach the standard. Of 27 patients with postoperative complications, 12 with postoperative hemorrhage received successful hemostasis by reoperations (7 with cystic artery hemorrhage and 5 with blood oozing from gallbladder bed); 8 with suppurative cholangitis received endoscopic retrograde cholangio-pancreatography and choledochotomy with drainage, including 2 deaths and 6 with improvement; 2 with common bile duct injury were improved by reoperation of choledochojejunostomy + T tube drainage; 2 were complicated with bile leakage induced to peritonitis and underwent bile duct repair with drainage, including 1 death and 1 with improvement; 2 with hepatic failure died of treatment failure; 1 with colonic injury was improved by reoperation of anastomosis. Of 223 patients, 207 didn′t receive postoperative adjuvant treatment and 16 received postoperative adjuvant treatment, including 8 with chemotherapy, 4 with radiotherapy, 2 with immunologic therapy and 2 with Chinese medicine treatment. (2) Follow-up and survival: of 223 patients, 193 were followed up for 6-90 months, with a median time of 33 months. Of 193 patients with follow-up: ① The operation of 2 patients in stage Tis reached the standard, including 1 with cholecystectomy and 1 with radical resection of gallbladder carcinoma, and the postoperative survival time of them were respectively 28 months and 52 months. ② The operation of 14 patients in stage T1a reached the standard, including 8 with cholecystectomy and 6 with radical resection of gallbladder carcinoma, and the postoperative survival time of them were respectively (74±5)months and (79±6)months. ③ Of 26 patients in stage T1b, 13 and 13 received respectively cholecystectomy and radical resection of gallbladder carcinoma (reaching the standard), and postoperative survival time of them were respectively (66±4)months and (76±8)months. ④ Of 68 patients in stage T2, 25, 37, 4 and 2 patients received respectively cholecystectomy, radical resection of gallbladder carcinoma (reaching the standard), extended radical resection of gallbladder carcinoma (reaching the standard) and palliative resection, and postoperative survival time of them were respectively (42±7)months, (66±6)months, (42±3)months and (26±3)months. ⑤ Of 71 patients in stage T3, 20, 48 and 3 patients received respectively cholecystectomy, radical resection of gallbladder carcinoma (reaching the standard) and extended radical resection of gallbladder carcinoma (reaching the standard), and postoperative survival time of them were respectively (39±8)months, (48±11)months and (10±6)months. ⑥ Of 12 patients in stage T4, 3, 1, 5 and 3 patients received respectively cholecystectomy, radical resection of gallbladder carcinoma (reaching the standard), extended radical resection of gallbladder carcinoma (reaching the standard) and palliative resection, and postoperative survival time of them were respectively (10±4)months, 12 months, (9±5)months and (11±3)months.
Conclusions:The intraoperative frozen section biopsy and pathological results are the key points for diagnosis and treatment of unexpected gallbladder carcinoma. Patients in stage Tis and T1a should undergo cholecystectomy, while patients in stage T1b and above should undergo radical resection of gallbladder carcinoma or extended radical resection of gallbladder carcinoma.