Primary gallbladder carcinoma: significance of subserosal lesions and results of aggressive surgical treatment and adjuvant chemotherapy.
Primary gallbladder carcinoma: significance of subserosal lesions and results of aggressive surgical treatment and adjuvant chemotherapy.
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原发性胆囊癌：浆膜下病变的意义以及积极手术治疗和辅助化疗的结果。
DOI：
10.5555/uri:pii:0039606083900284
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发表时间：
1983
期刊：
影响因子：
3.8
通讯作者：
T. Grage
中科院分区：
文献类型：
--
作者：
C. Morrow;D. Sutherland;G. Florack;M. M. Eisenberg;T. Grage
胆道疾病诊断方法的进步并没有改善原发性胆囊癌的低生存率。我们对112例胆囊癌患者的手术结果进行分析。局限于胆囊壁的肿瘤和晚期疾病需要积极手术治疗和辅助化疗的肿瘤分别根据以下分期系统进行分析：局限于粘膜的肿瘤（分期，I期，n = 4）；侵及肌层的肿瘤（II期，n = 4）；浆膜下肿瘤（III期，n = 3）；伴有囊性淋巴结受累的肿瘤（IV期，n = 13）；肿瘤扩散到邻近器官（V期，n = 88）。在肿瘤局限于胆囊壁的11例患者（10%）中，5例患者中有1例（20%）单独行胆囊切除术，6例患者中有4例（60%）行胆囊切除术和淋巴结切除术（3例肝楔切除术和1例胰十二指肠切除术）术后3 - 6年存活且无肿瘤。3例单独行胆囊切除术的患者分别于术后18、48和60个月死于复发性肿瘤。在13例囊性淋巴结受累（IV期）患者中，9例单独行胆囊切除术，3例行淋巴结切除术，1例行胰十二指肠切除术；6个月时的累计生存率仅为37%，所有患者均在18个月内死亡。14例晚期疾病（V期）患者接受积极手术治疗，包括6例淋巴结切除术，6例肝楔切除术，2例右肝叶切除术，平均生存率仅为3个月。
Advances in methods to diagnose biliary disease have not improved the dismal survival rates reported for primary gallbladder cancer. We analyzed the results of operation in 112 patients with gallbladder cancer. Tumors limited to the gallbladder wall and those that required aggressive surgical therapy and adjuvant chemotherapy for advanced disease were analyzed separately according to the following staging system: tumors that were localized to the mucosa (stage, I, n = 4); tumors that penetrated the muscularis (stage II, n = 4); subserosal tumors (stage III, n = 3); tumors with cystic node involvement (stage IV, n = 13); and tumors that had spread to adjacent organs (stage V, n = 88). Of the 11 patients (10%) with tumor limited to the gallbladder wall (stages I to III), one of five patients (20%) treated with cholecystectomy alone and four of six patients (60%) treated with cholecystectomy and lymphadenectomy (with hepatic wedge resection in three and pancreaticoduodenectomy in one) were alive and tumor free 3 to 6 years after operation. Three patients treated with cholecystectomy alone died of recurrent cancer at 18, 48, and 60 months after operation. Of the 13 patients with cystic node involvement (stage IV), nine were treated by cholecystectomy alone, three with lymphadenectomy, and one with pancreaticoduodenectomy; the cumulative survival rate was only 37% at 6 months, and all patients were dead within 18 months. Of 14 patients with advanced disease (stage V) treated with aggressive surgical therapy, including lymphadenectomy in six patients, hepatic wedge resection in six patients, and right hepatic lobectomy in two patients, the mean survival rate was only 3 months.