Shimada H, Endo I, Fujii Y, Kamiya N, Masunari H, Kunihiro O, Tanaka K, Misuta K, Togo S
Department of Surgery II, Yokohama City University, School of Medicine, Yokohama, Japan.
Langenbecks Arch Surg. 2000 Dec;385(8):509-14. doi: 10.1007/s004230000163.
Radical lymph node dissection in surgery for advanced gallbladder cancer is controversial. The purpose of this study is to evaluate the role of lymph node dissection based on the clinico-pathologic results.
Seventy-three patients who underwent radical surgery including systematic dissection of the N1+N2 region lymph node plus some of the para-aortic nodes were reviewed.
pT1 patients had no lymph node metastasis, but pT2 and pT3/pT4 patients had lymph node metastasis at a rate of 50.0% (13/26) and 83.3% (25/30), respectively. As infiltration of the hepatoduodenal ligament (Binf) became severe, the rate and extent of lymph node metastasis increased. There were four 5-year survivors with lymph node involvement. The 5-year survival rates are 77.0% in pN0 cases and 27.3% in pN1 cases (P<0.01). There was no difference in survival between pN1 and pN2 patients. However, significant differences in survival were observed between pN0/1 and pN2/3 patients when these patients were limited to Binf0/1. Examination of the recurrence pattern showed that most patients with pN0/1/2 had no regional lymph node recurrence, but there was para-aortic lymph node recurrence in patients with pN3 outside the dissected region. Significant prognostic factors influencing survival after surgery by multivariate analysis were pN2/3, pT, and residual tumor.
Systematic lymph node dissection of N1, N2, and part of the para-aortic region improves survival in advanced gallbladder cancer patients, especially in those without either para-aortic lymph node metastases or Binf2/3.
晚期胆囊癌手术中的根治性淋巴结清扫存在争议。本研究旨在根据临床病理结果评估淋巴结清扫的作用。
回顾了73例行根治性手术的患者，包括系统性清扫N1+N2区域淋巴结以及部分腹主动脉旁淋巴结。
pT1患者无淋巴结转移，但pT2和pT3/pT4患者的淋巴结转移率分别为50.0%（13/26）和83.3%（25/30）。随着肝十二指肠韧带（Binf）浸润加重，淋巴结转移率和转移范围增加。有4例有淋巴结受累的患者存活5年。pN0病例的5年生存率为77.0%，pN1病例为27.3%（P<0.01）。pN1和pN2患者的生存率无差异。然而，当将这些患者限于Binf0/1时，pN0/1和pN2/3患者的生存率存在显著差异。复发模式检查显示，大多数pN0/1/2患者无区域淋巴结复发，但在清扫区域外的pN3患者中有腹主动脉旁淋巴结复发。多因素分析显示，影响术后生存的重要预后因素为pN2/3、pT和残留肿瘤。
系统性清扫N1、N2和部分腹主动脉旁区域淋巴结可提高晚期胆囊癌患者的生存率，尤其是那些无腹主动脉旁淋巴结转移或Binf2/3的患者。
