Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification
Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification
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DOI：
10.1007/s00534-006-1188-z
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发表时间：
2007-07-01
期刊：
影响因子：
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通讯作者：
Miyazaki, Masaru
中科院分区：
文献类型：
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作者：
Shimizu, Hiroaki;Kimura, Fumio;Miyazaki, Masaru
背景/目的。积极手术治疗IV期胆囊癌的作用仍有争议。根据日本胆道外科学会（JSBS）的分类，分析IV期疾病患者的生存和预后因素，以确定可以从根治性手术中获益的患者组。回顾性分析了79例JSBS IV期胆囊癌患者，这些患者在我院接受了手术切除以达到治疗目的。标准术式为解剖性S4a + S5亚节段切除术(n = 29) +肝外胆管切除术和扩大淋巴结切除术，但当累及右侧Glisson氏鞘和/或肝门部时，选择右侧扩大肝切除术（n = 34）或右侧三节切除术（n = 3）。为达到无肿瘤边缘，12例患者行胰十二指肠联合切除术，17例患者行大血管切除术。四期胆囊癌患者的治愈率为65.8%，住院死亡率为11.4%。根治切除后5年生存率为13.7%。单因素分析显示，治愈率、肝十二指肠韧带侵犯、淋巴结受累和血管切除是重要的预后因素。肝浸润和肝转移均不是重要因素。即使在肝十二指肠韧带侵犯和淋巴结侵犯没有或有限的IV期患者，也应考虑积极的手术切除。这类患者只有在治愈性切除后才能获得可接受的生存率。
Background/Purpose. The role of aggresive surgery for stage IV gallbladder carcinoma remains controversial. Survival and prognostic factors were analyzed in patients with stage IV disease, based on the Japanese Society of Biliary Surgery (JSBS) classification, to identify the group of patients who could benefit from radical surgery.Methods. A retrospective analysis was done of 79 patients with JSBS stage IV gallbladder carcinoma who had undergone surgical resection with curative intent at our institution. The standard procedures were anatomical S4a + S5 subsegmentectomy (n = 29) with extrahepatic bile duct resection and extended lymphadectomy, but when right Glisson's sheath and/or the hepatic hilum were involved, right extended hepatectomy (n = 34) or right trisegmentectomy (n = 3) was selected. To achieve a tumor-free margin combined pancreaticoduodenectomy was performed in 12 patients, and major vascular resection in 17 patients.Results. In the patients with stage IV gallbladder carcinoma, the curative resection rate was 65.8% and the hospital mortality rate was 11.4%. The postoperative 5-year survival rate following curative resection was 13.7%. Univariate analysis indicated that curability, hepatoduodenal ligament invasion, nodal involvement, and vascular resection were significant prognostic factors. Neither hepatic invasion nor liver metastasis was a significant factor.Conclusions. Aggressive surgical resection should be considered even in stage IV patients when hepatoduodenal ligament invasion and nodal involvement are absent or limited. Acceptable survival may be expected among such patients only when curative resection is achieved.