Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer?
Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer?
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DOI：
10.1016/j.surg.2004.04.032
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发表时间：
2004-11-01
期刊：
影响因子：
3.8
通讯作者：
Miyazaki, M
中科院分区：
文献类型：
--
作者：
Shimizu, Y;Ohtsuka, M;Miyazaki, M
背景。胆囊癌扩散至肝十二指肠韧带的发生率和扩散方式在病理上尚未得到很好的描述，胆囊癌扩散至浆膜下及其他部位。1985年至2002年间，连续50例胆囊癌延伸至浆膜下或更远的患者接受了根治性手术，包括肝外胆管切除术。对切除的肝外胆管标本进行连续切片检查，以确定原发性肿瘤对肝十二指肠韧带的侵犯发生率和模式。50例标本中有30例肝十二指肠韧带受累。其中，9例表现为直接膜外扩散（1型），4例表现为连续膜内扩散（II型），5例表现为与原发肿瘤分离的远处扩散（III型），4例表现为转移性淋巴结的癌细胞扩散（IV型）。其余8例患者有1种以上类型：1例为I + III型；I + III + IV型3例；44例术前无梗阻性黄疸患者中有24例，13例IB期患者中有2例出现肝十二指肠韧带侵犯。II型、III型和IV型扩散至肝十二指肠韧带患者的生存率明显高于I型扩散患者。胆囊癌向浆膜下或浆膜外侵犯肝十二指肠韧带的频率较高。这种侵袭的术前诊断是困难的；因此，应强烈考虑切除肝外胆管和淋巴结。
Background. The incidence and mode of spread of carcinoma of the gallbladder into the hepatoduodenal ligament have not been well described pathologically for gallbladder carcinoma extending into the subserosa and beyond.Methods. Between 1985 and 2002, 50 consecutive patients with gallbladder carcinoma extending into the subserosa or beyond underwent radical surgery, including extrahepatic bile duct resection. Serial sections of specimens of the resected extrahepatic bile ducts were examined to determine the incidence and the pattern of invasion of the hepatoduodenal ligament from the primary cancer.Results. Invasion of the hepatoduodenal ligament was present in 30 of the 50 specimens. Of these, 9 showed direct extramural spread (type 1), 4 showed continuous intramural spread (type II), 5 showed distant spread separated from the primary tumor (type III), and 4 showed spread of cancer cells from metastatic lymph nodes (type IV). The remaining 8 patients had more than 1 type: I patient had types I + III; 3 had types I + III + IV; and 4 had types III + IV Invasion of the hepatoduodenal ligament was present in 24 of 44 patients without preoperative obstructive jaundice and in 2 of 13 patients with stage IB disease. Patients with types II, III, and IV spread into the hepatoduodenal ligament had significantly better survival than those with type I spread.Conclusions. Gallbladder carcinoma extending into the subserosa or beyond invades the hepatoduodenal ligament with relatively high frequency. Preoperative diagnosis of this invasion is difficult; therefore, strong consideration should be given to resection of the extrahepatic bile ducts and lymph nodes.