İnsidental safra kesesi kanseri: 3856 kolesistektominin incelemesi

Öz

Amaç: Safra kesesi kanseri (SKK), ABD'de yılda 5000'den fazla yeni vakaya neden olan ender görülen ancak ölümcül bir hastalıktır. Ameliyat öncesi dönemde SKK olgularının %20'sinden azında teşhis konulur. Kalan olgular laparoskopik kolesistektomi sonrası ya da intraoperatif olarak teşhis edilir. SKK, laparoskopik kolesistektomilerin %0,25-3'ünü takiben tesadüfen histopatoloji sırasında saptanır. Bununla birlikte insidental SKK, tüm SKK’ların %74-92'sini oluşturmaktadır. Bu hastalıkta en önemli adım doğru evrelendirilmedir. Evreleme, hastalık yönetimi ve tedavi seçeneklerini belirler ve sürviyi öngörür. SKK tedavisinde küratif ameliyatlar, lokal rezektabl hastalık ile sınırlıdır. Bu çalışmada kolesistektomi sonrası insidental tespit edilen SKK ve premalign safra kesesi lezyonu olan biliyer intraepitelial neoplazi (BillIn) (safra kesesi displazisi) olgularını sunmak amaçlanmıştır.
Yöntemler: Çalışma evrenini 2009-2017 yılları arasında kolesistektomi gerçekleştirilen 3856 hasta oluşturdu. Histopatolojik inceleme sonucunda insidental olarak saptanan SKK (sekiz hasta (%0,21)) ve BillIn (beş hasta (%0,12)) tanısı alan hastalar irdelendi. Hastalar demografik veriler, histopatoloji, ameliyat raporları ve takipler açısından kayıt edildi.
Bulgular: Çalışma grubunda SKK ve BillIn olmak üzere toplam 13 (%0,33) hasta tespit edildi. Hastaların ortalama yaşı 54,8±14,3 (yaş aralığı 33-83), yedisi erkek ve altısı kadın idi. Çalışma evreninde tespit edildiği kadarıyla kolesistektomi kadınlarda (%72,7) daha sık yapılmasına rağmen, SKK erkek cinsiyette daha sık görüldü (p<0,05).
Sonuç: SKK ve BillIn safra taşı hastalığına yönelik kolesistektomi sonrası tesadüfen rastlanan histopatolojik bulgulardır. Diğer gastrointestinal kanserlere göre, SKK sağkalımı düşük olan kanserlerdendir. Literatürde önerilen ameliyat öncesi yakın zamanda gerçekleştirilecek görüntüleme tetkikleri, gereğinde frozen inceleme yapılması ve gerekebilecek ileri tedavilere hazırlıklı olmaktır.

Anahtar Kelimeler

• Safra kesesi,İnsidental kanser,Kolesistektomi

Incidental gallbladder cancer: Review of 3856 cholecystectomies

Abstract

Aim: Gallbladder cancer (GBC) is a rare but fatal disease that causes more than 5000 new cases per year in the United States. In the pre-operative period, it is diagnosed in less than 20% of the cases of GBC. The remaining cases are diagnosed after laparoscopic cholecystectomy or intraoperative. Following the 0.25-3% of laparoscopic cholecystectomy, GBC is incidentally detected during histopathology. However, the incidental GBC constitutes 74-92% of all GBCs. The most important step in this disease is the correct staging. Staging determines disease management and treatment options and predicts survival. Curative surgeries in the treatment of GBC are limited to local resectable disease. In this study, it was aimed to present cases of GBC which was diagnosed incidentally after cholecystectomy and premalignant gallbladder lesions (BillIn: Biliary intraepithelial neoplasia).
Methods: 3856 patients who underwent cholecystectomy between 2009 and 2017 constituted the study universe. Patients who were diagnosed as incidental GBC (eight patients (0.21%)) and BillIn (five patients (0.12%)) were examined as a result of histopathological examination. The patients were recorded in terms of demographic data, histopathology, surgical reports and follow-up.
Results: A total of 13 (0.33%) patients were detected in the study group, including GBC and BillIn. The mean age of patients was 54.8±14.3 (age range 33-83), seven male and six women. Although cholecystectomy was performed more frequently in women (72.7%) as determined in the study universe, GBC was seen more frequently in male gender (p<0.05). Distribution of tumor stage in malignant patients was identified; four patients were observed in T2, three patients T1a and T3 GBC in one patient, BillIn in five patients.
Conclusion: GBC and BillIn are rare histopathological findings which are detected after cholecystectomy performed due to gallstone disease. Mean survival time of GBC is lower than other gastrointestinal cancers. The recent pre-operative examinations and a frozen-section examination in case of malignancy suspicion has been suggested in the literature, therefore surgeons should be prepared for advanced therapies.

Keywords

• Gallbladder,Incidental cancer,Cholecystectomy

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