Kurokawa T, Nonami T, Nakao A, Okuda N, Harada A, Takagi H
Department of Surgery II, Nagoya University School of Medicine, Japan.
Hepatogastroenterology. 1999 May-Jun;46(27):1561-6.
BACKGROUND/AIMS: Owing to recent advances in diagnostic and surgical techniques, aggressive operations for advanced gallbladder carcinoma are becoming more safe. However, the role of a radical operation in terms of long-term survival remains controversial. In this study, we reviewed our experience with gallbladder carcinoma and the literature to clarify the present status of this strategy.
So far in our department, we have treated 88 patients with gallbladder carcinoma and resection was performed in 46 of them. Stages, operative procedures, results of pathologic examinations and the outcome of the resected cases were reviewed.
Only 6 of the 46 patients belonged to the early stage (stage I and II in Nevin staging system, or stage I in TNM staging system) and had a good prognosis. Cholecystectomy with regional lymph node resection was performed in 13 patients. In other patients, more radical procedures including adjacent organ resection were performed according to the spread of the cancer. Major hepatectomy and pancreatoduodenectomy were additionally performed on 8 and 6 patients, respectively. Portal vein resection and reconstruction were performed in 3 patients. The survival rate in advanced cases was poor, but we had 5 long-term (more than 4 years) survivors among 40 patients in the advanced stages. Moreover, one patient undergoing a combination of extended right lobectomy of the liver, pancreato-duodenectomy with portal vein resection and extended node resection of the paraaortic nodes, survived for 3 years and 3 months until she died of another disease.
The prognosis is still not good in patients with advanced gallbladder carcinoma even if radical resection is performed. However, a number of our patients who underwent radical surgery survived a long time.
背景/目的：由于诊断和手术技术的最新进展，针对晚期胆囊癌的积极手术正变得更加安全。然而，根治性手术在长期生存方面的作用仍存在争议。在本研究中，我们回顾了我们治疗胆囊癌的经验以及相关文献，以阐明该策略的现状。
到目前为止，我们科室共治疗了88例胆囊癌患者，其中46例行手术切除。回顾了分期、手术方式、病理检查结果以及切除病例的结局。
46例患者中仅6例属于早期（Nevin分期系统中的I期和II期，或TNM分期系统中的I期），预后良好。13例患者行胆囊切除术加区域淋巴结清扫。其他患者根据癌症的扩散情况进行了更根治性的手术，包括邻近器官切除。另外分别有8例和6例患者行肝大部切除术和胰十二指肠切除术。3例患者行门静脉切除及重建。晚期病例的生存率较差，但在40例晚期患者中有5例长期（超过4年）存活者。此外，1例患者接受了扩大右半肝切除术、门静脉切除的胰十二指肠切除术及腹主动脉旁淋巴结扩大清扫术联合治疗，存活3年3个月，直至死于其他疾病。
即使行根治性切除，晚期胆囊癌患者的预后仍然不佳。然而，我们的许多接受根治性手术的患者存活了很长时间。
