Hepatoduodenal ligament invasion by gallbladder carcinoma: Histologic patterns and surgical recommendation
Hepatoduodenal ligament invasion by gallbladder carcinoma: Histologic patterns and surgical recommendation
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DOI：
10.1007/s00268-002-6702-0
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发表时间：
2003-03-01
影响因子：
2.6
通讯作者：
Suzuki, M
中科院分区：
文献类型：
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作者：
Kaneoka, Y;Yamaguchi, A;Suzuki, M
关于胆囊癌侵犯肝十二指肠韧带（HDL）的最佳治疗方案尚未达成共识。我们回顾性地将 HDL 侵袭模式与手术结果相关联。从1985年到2000年，59名患者接受了肝外胆管和胆囊以及邻近器官的联合切除术（如果需要）。病理分期（UICC）为II期，4期；阶段，III，14； IVa期，10； IVb期，31。肝十二指肠韧带侵犯分为淋巴结受累（LNI）和胆管浸润（BDI）。将 HDL 侵袭模式与胆管形态、可切除性和结果进行比较。胆管浸润 (n = 32) 在所有病例中均导致胆管狭窄，而 LNI (n = 40) 仅在 4 例中导致胆管狭窄。扩大胆囊切除术 (n = 22) 后完成切除的率为 36%； 4b/5 肺段切除术 (n = 10) 占 90%；主要肝切除术 (n = 2) 占 50%； 53% 的病例接受胰十二指肠切除术 (n = 17)。对于没有 BDI 的患者，手术治愈率为 75%，而对于 BDI 患者，手术治愈率 < 30%。阻碍 BDI 根治性切除的最常见因素是 HDL 周围的神经周围浸润。超过 70% 的病例神经周围侵犯发生在胆管切端或解剖边缘。排除R2切除（残余癌症）和医院死亡患者的3年生存率为LNI（-）BDI（-）（n = 8），65.6％； LNI(+)BDI(-)（n = 17），35.3%； LNI(-)BDI(+) (n = 704.3%；LNI(+)BDI(+) (n = 17)，5.9%。BDI 患者没有 5 年幸存者。总之，BDI 神经周围侵犯是完全切除的重要障碍。肝胰十二指肠切除术是仅针对 LNI(+)BDI(-) 疾病的可行策略。
A consensus for the optimal management of hepatoduodenal ligament (HDL) invasion by gallbladder carcinoma has yet to be reached. We retrospectively correlated the patterns of HDL invasion with the surgical outcome. From 1985 to 2000,59 patients underwent combined resection of the extrahepatic bile duct and gallbladder and contiguous organs if required. Pathologic staging (UICC) was stage II, 4; stage,III, 14; stage IVa, 10; and stage IVb, 31. Hepatoduodenal ligament invasion was subdivided into lymph node involvement (LNI) and bile duct infiltration (BDI). Patterns of HDL invasion were compared with bile duct morphology, resectability, and outcome. Bile duct infiltration (n = 32) caused stenosis of the bile duct in all cases, whereas LNI (n = 40) caused stenosis in only 4 cases. Resection was complete after extended cholecystectomy (n = 22) in 36%; 4b/5 segmentectomy (n = 10) in 90%; major hepatectomy (n = 2) in 50%; and bepatopancreatoduodenectomy (n = 17) in 53% of cases. Surgery was curative in 75% of patients without BDI, and was < 30% with BDI. The most common factor preventing curative resection in BDI was perineural invasion around the HDL. Perineural invasion occurred in over 70% of cases at either the cut end of the bile duct or in the margin of dissection. The 3-year survival rates, excluding patients with R2 resection (residual cancer) and death in hospital, were LNI(-)BDI(-) (n = 8), 65.6%; LNI(+)BDI(-) (n = 17), 35.3%; LNI(-)BDI(+) (n = 704.3%; and LNI(+)BDI(+) (n = 17), 5.9%. There were no 5-year survivors with BDI. In conclusion, perineural invasion in BDI is an important obstacle to complete resection. Hepatopancreatoduodenectomy is a feasible strategy only for LNI(+)BDI(-) disease.