Kondo S, Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K, Yuasa N, Sano T, Hayakawa N
First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
J Hepatobiliary Pancreat Surg. 2001;8(6):511-7. doi: 10.1007/s005340100018.
To describe 5-year survivors after radical surgery for stage IV gallbladder cancer and to determine the characteristics leading to potential long-term survival.
Of 59 patients undergoing radical resection for stage IV disease between 1979 and 1994, 6 patients who have survived for more than 5 years were followed up.
Three patients had developed obstructive jaundice due to involvement of the hepatic hilum, but the other three had not. The jaundiced patients had remarkable tumor spread over the bile duct and right hepatic artery within the hepatoduodenal ligament. However, the proper and left hepatic arteries and the portal trunk and its left branch were free from tumor involvement. The nonjaundiced patients had N1 or N2 lymph node metastasis. However, none underwent bile duct resection or pancreatoduodenectomy to establish radical lymphadenectomy.
Selected patients with stage IV gallbladder cancer may be candidates for 5-year survival when the primary tumor is fairly localized even if it forms a large mass and involves neighboring organs including the hepatic duct, lymph node metastasis is limited to N1 and N2 except for the celiac and superior mesenteric nodes and is less infiltrative, and distant metastasis including that in the paraaortic area is absent.
描述IV期胆囊癌根治性手术后生存5年以上的患者情况，并确定可能实现长期生存的特征。
在1979年至1994年间接受IV期疾病根治性切除的59例患者中，对6例存活超过5年的患者进行了随访。
3例患者因肝门受累出现梗阻性黄疸，而另外3例未出现。出现黄疸的患者在肝十二指肠韧带内的胆管和肝右动脉有明显的肿瘤扩散。然而，肝固有动脉和肝左动脉以及门静脉主干及其左支未受肿瘤侵犯。未出现黄疸的患者有N1或N2淋巴结转移。然而，无人接受胆管切除或胰十二指肠切除术以进行根治性淋巴结清扫。
对于部分IV期胆囊癌患者，即使原发肿瘤形成较大肿块并累及包括肝管在内的邻近器官，但如果原发肿瘤相当局限，淋巴结转移限于N1和N2（不包括腹腔和肠系膜上淋巴结）且浸润性较小，并且不存在包括主动脉旁区域转移在内的远处转移，则可能有5年生存的机会。
