A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma
A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma
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DOI：
10.1007/s11605-007-0181-4
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发表时间：
2007-08-01
影响因子：
3.2
通讯作者：
Kondo, Kazuhiro
中科院分区：
文献类型：
--
作者：
Kai, Masahiro;Chijiiwa, Kazuo;Kondo, Kazuhiro
本研究的目的是根据日本胆道外科学会（JSBS）分类系统评估我们90例胆囊癌手术的结果，并根据原发肿瘤浸润深度和淋巴结转移阐明晚期胆囊癌的适当手术策略。一般来说，只有手术切除才能改善晚期胆囊癌的预后。这种肿瘤患者的生存率严格取决于组织学原发肿瘤浸润和淋巴结转移的深度。方法回顾性分析1990 ~ 2004年90例胆囊癌手术治疗的临床资料。研究了影响生存的因素。39例姑息治疗患者（未切除病例），术前影像学诊断为T3或T4，也纳入本研究。通过Kaplan-Meier方法和对数秩检验检查变量对生存的显著性，然后使用考克斯比例风险模型进行多变量分析。多因素分析显示，门脉侵犯、淋巴结转移、手术切缘（+ vs. -）和最终治愈率（fCurA，B vs. C）均为独立的预后因素。在pT 2胆囊癌中，以S4 a + S5肝切除术、扩大胆囊切除术和胆囊切除术的顺序，采用积极的手术方式获得了更好的生存率。在pT 3和pT 4中，尽管根治性扩大手术即使在肝叶切除术后也不能提供良好的生存机会，但根治性手术患者的生存率在统计学上优于未根治性手术患者。此外，pN 1至pN 2的淋巴结受累优于pN 3。因此，S4 a + S5肝切除术似乎足以治疗pT 2胆囊癌。即使在pT 3和pT 4胆囊癌患者中，无肿瘤手术切缘的手术也可以预期长期生存。然而，根治性手术的作用被认为是有限的pN 3淋巴结转移患者。
The aim of this study was to evaluate the results of our series of 90 operations for gallbladder carcinoma according to the Japanese Society of Biliary Surgery (JSBS) classification system and to clarify the appropriate surgical strategy for advanced gallbladder carcinoma based on the depth of primary tumor invasion and lymph node metastasis. Generally, only a surgical resection can achieve a prognostic improvement of the advanced gallbladder carcinoma. The survival of patients with this neoplasm depends strictly on the depth of histological primary tumor invasion and lymph node metastasis. A retrospective analysis was conducted on 90 patients from 1990 to 2004 who underwent a surgical resection of gallbladder carcinoma. The factors influencing survival were examined. Thirty-nine patients with palliative treatment ( not resected cases), which was diagnosed as T3 or T4 by preoperative imagings, were also included in this study. The significance of the variables for survival was examined by the Kaplan - Meier method and the log-rank test followed by multivariate analyses using Cox's proportional hazard model. Portal invasion, lymph node metastasis, the surgical margin (+ vs. -) and the final curability (fCurA, B vs. C) were all found to be independent prognostic factors in the multivariate analysis. In pT2 gallbladder carcinoma, a better survival was achieved in an aggressive surgical approach, in order of a S4a+ S5 hepatic resection, an extended cholecystectomy and a cholecystectomy. In pT3 and pT4, although radical extended surgery did not provide the opportunity for good survival even after lobectomy of the liver, the survival of patients with curative surgery was statistically better than in those without curative surgery. In addition, the nodal involvement of pN1 to pN2 was better than that with pN3. A S4a+ S5 hepatectomy, therefore, appears to be adequate for the treatment of pT2 gallbladder carcinoma. Even in patients with pT3 and pT4 gallbladder carcinoma, long-term survival can be expected by an operation with a tumor-free surgical margin. The role of radical surgery, however, is considered to be limited in patients with pN3 lymph node metastasis.