Suzuki M, Unno M, Oikawa M, Endo K, Katayose Y, Matsuno S
First Department of Surgery, Tohoku University School of Medicine, Miyagi, Japan.
Hepatogastroenterology. 2000 May-Jun;47(33):650-7.
BACKGROUND/AIMS: Recently, the Japanese Classification on Cancer of the Biliary Tract was revised and adopted the new comprehensive staging that is similar to UICC's TNM classification. We should be paying close attention to the significance of newly defined extensive factors of carcinomas on the long-term prognosis.
The surgical outcome for 99 patients who underwent resected middle (Bm) and lower (Bi) bile duct carcinomas was reviewed in order to evaluate the suitability of the surgical procedures employed for their treatment, namely, standard pancreatoduodenectomy for Bi carcinoma and bile duct resection with D2 lymph node dissection for Bm carcinoma.
The overall 5-year cumulative survival rate (operative death excluded) of Bm and Bi carcinoma patients was 37.4% and the 5-year survival rate of the patients in whom surgical curability (curA) was accomplished was 51.6%. Recently, a new prognostic factor, "t-category", which indicates the degree of pericholedochal neoplastic invasion was proposed in the 4th edition of the Japanese General Rules for Surgical and Pathological Studies on Cancer of the Biliary Tract. The 10-year survival rates by t-category were 49.1% (t1), 19.7% (t2), and 0% (t3 and t4) respectively. For Bm carcinoma, the patients undergoing bile duct resection under the condition of curA showed excellent prognoses. For Bi carcinoma, the patients fulfilling particular histological criteria, i.e., those concerning the histological depth of neoplastic invasion (m, fm, panc1a), duodenal involvement (du0, du1), vascular invasion (pv0), pericholedochal neoplastic invasion (t1), lymph node metastasis (n0), and comprehensive stage I, had good postoperative outcomes. Taking into account the fact that the metastatic rate of paragastric lymph nodes was 1.3%, the cases of panc0,1 should be operated by pylorus-preserving pancreatoduodenectomy. The overall 5-year survival rates including far-advanced cases were 39.9% in Bm carcinoma patients and 36.9% in Bi carcinoma patients. However, these postoperative outcomes are far from satisfactory.
Therefore, we concluded that pancreatoduodenectomy and pylorus-preserving pancreatoduodenectomy with extended D3 lymphadenectomy combined with systematic multimodal therapy are indicated in each and every case of Bm and Bi carcinoma.
背景/目的：最近，日本胆道癌分类进行了修订，采用了与国际抗癌联盟（UICC）的TNM分类相似的新综合分期。我们应密切关注新定义的癌广泛因素对长期预后的意义。
回顾了99例行中（Bm）下段（Bi）胆管癌切除术患者的手术结果，以评估所采用治疗手术方法的适用性，即Bi癌行标准胰十二指肠切除术，Bm癌行胆管切除加D2淋巴结清扫术。
Bm和Bi癌患者总的5年累积生存率（排除手术死亡）为37.4%，手术治愈（curA）患者的5年生存率为51.6%。最近，在日本胆道癌外科和病理研究总则第4版中提出了一个新的预后因素“t分类”，它表明胆管周围肿瘤侵犯程度。按t分类的10年生存率分别为49.1%（t1）、19.7%（t2）和0%（t3和t4）。对于Bm癌，在curA条件下行胆管切除术的患者预后良好。对于Bi癌，符合特定组织学标准的患者，即那些涉及肿瘤侵犯组织学深度（m、fm、panc1a）、十二指肠受累（du0、du1）、血管侵犯（pv0）、胆管周围肿瘤侵犯（t1）、淋巴结转移（n0）和综合分期I的患者，术后效果良好。考虑到胃周淋巴结转移率为1.3%，panc0,1病例应行保留幽门的胰十二指肠切除术。包括晚期病例在内，Bm癌患者总的5年生存率为39.9%，Bi癌患者为36.9%。然而，这些术后结果远不能令人满意。
因此，我们得出结论，对于每一例Bm和Bi癌患者，均应行胰十二指肠切除术和保留幽门的胰十二指肠切除术加扩大D3淋巴结清扫术，并联合系统多模式治疗。
