Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage
Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage
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DOI：
10.1016/s0039-6060(96)80089-4
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发表时间：
1996-11-01
期刊：
影响因子：
3.8
通讯作者：
Yoshida, K
中科院分区：
文献类型：
--
作者：
Tsukada, K;Hatakeyama, K;Yoshida, K
背景手术在胆囊癌（GBC）治疗中的作用是有争议的。根据肿瘤的TNM分期讨论了GBC前瞻性根治性手术后的结果。选择了106例接受根治性手术的患者。标准根治性手术包括胆囊切除术，伴有淋巴结清扫，肝楔形切除术和肝外胆管切除术。根据手术切除的肿瘤组织病理学检查确定其分期。在T1肿瘤患者（n = 15）、T2肿瘤患者（n = 46）、T3肿瘤患者（n = 25）和T4肿瘤患者（n = 20）中分别未发现淋巴结转移（n = 48%、72%和80%）。1例患者在根治性手术后30天内死亡（死亡率，0.9%）。有35名5年生存者，包括11名淋巴结受累患者，10名I期肿瘤患者，13名II期肿瘤患者，10名III期肿瘤患者，2名IV期肿瘤患者。I期肿瘤患者的累积5年生存率为91%（n = 15），II期肿瘤患者为85%（n = 24），III期肿瘤患者为40%（n = 28），IV期肿瘤患者为19%（n = 39）。在III期和IV期肿瘤患者中，根治性切除术后的5年生存率为52%（n = 35）。这明显优于非治愈性切除后5%的5年生存率（n = 32）。淋巴结转移的存在受到原发肿瘤浸润深度的强烈影响。准确确定TNM分期对于比较手术结果、预测患者结局和计划额外治疗至关重要。标准根治性手术有助于患者生存，并推荐用于晚期GBC患者。
Background. The role of surgery in the treatment of gallbladder carcinoma (GBC) is controversial. The outcome after prospective radical surgery for GBC is discussed on the basis of the TNM stage of the tumor.Methods. One hundred six patients who had undergone radical surgery were selected. The standard radical procedure consisted of a cholecystectomy accompanied by lymph node dissection, wedge resection of the liver, and resection of the extrahepatic bile ducts. The stage was determined by pathologic examination of resected specimens.Results. Lymph node metastases were identified in no patients with T1 tumors (n = 15), 48% of patients with T2 tumors (n = 46), 72% of patients with T3 tumors (n = 25), and 80% of patients with T4 tumors (n = 20). One patient died within 30 days after radical surgery (mortality rate, 0.9%). There were 35 5-year survivors including 11 patients with nodal involvement, 10 with stage I tumors, 13 with stage II tumors, 10 with stage III tumors, and 2 with stage IV turners. The cumulative 5-year survival rate In patients with stage I tumors was 91% (n = 15), 85% in patients with stage II tumors (n = 24), 40% in patients with stage III tumors (n = 28), and 19% in patients with stage IV tumors (n = 39). In patients with stage III and IV tumors the 5-year survival rate was 52% after curative resection (n = 35). This was significantly better than the 5% 5-year survival rate after a noncurative resection (n = 32).Conclusions. The presence of lymph node metastases is strongly influenced try the depth of invasion of the primary tumor. Accurate determination of the TNM Stage is essential in comparing surgical results, predicting-patient outcome, and planning additional treatment. Standard radical surgery contributes to patient survival and is recommended in patients with advanced GBC.