Sasaki Ryoko, Takahashi Masahiro, Funato Osamu, Nitta Hiroyuki, Murakami Masahiko, Kawamura Hidenobu, Suto Takayuki, Kanno Senji, Saito Kazuyoshi
Department of Surgery I, Iwate Medical University School of Medicine, Department of Surgery, Iwate Prefectural Senmaya Hospital, Morioka, Japan.
Hepatogastroenterology. 2002 Jul-Aug;49(46):912-5.
BACKGROUND/AIMS: Although hepatopancreatoduodenectomy with wide lymph node dissection has been conducted for patients with locally advanced gallbladder carcinoma, the clinical usefulness of this radical procedure has not yet been estimated.
Morbidity, mortality, and outcome were analyzed retrospectively for 16 consecutive patients undergoing hepatopancreatoduodenectomy.
One in-hospital fatality (6.3%) and 11 postoperative complications occurred (69%). Overall 5-year survival in this procedure was 42.9%. The 5-year survival of patients undergoing potentially curative resection (52.7%) was significantly better (P = 0.016) than those with residual tumor (0%). There was no significant correlation in 5-year survival between patients with and without lymph node metastasis. Five patients (31%) survived 5 years. Of these, 4 had Stage IVB disease, and 2 had pN2 disease. Two patients with pM1 (lymph) disease died of the disease 6 months and the other 7 months after surgery, respectively.
Hepatopancreatoduodenectomy with wide lymph node dissection is an effective treatment for the selected patients with locally advanced gallbladder carcinoma with until pN2 disease, if curative resection is potentially feasible. Surgery is not indicated in those with pM1 (lymph) disease.
背景/目的：尽管已对局部晚期胆囊癌患者实施了伴有广泛淋巴结清扫的肝胰十二指肠切除术，但这种根治性手术的临床实用性尚未得到评估。
对连续16例行肝胰十二指肠切除术的患者的发病率、死亡率及预后进行回顾性分析。
1例院内死亡（6.3%），11例出现术后并发症（69%）。该手术的总体5年生存率为42.9%。接受潜在根治性切除患者的5年生存率（52.7%）显著高于有残留肿瘤的患者（0%）（P = 0.016）。有无淋巴结转移患者的5年生存率无显著相关性。5例患者（31%）存活5年。其中，4例为IVB期疾病，2例为pN2期疾病。2例pM1（淋巴）期疾病患者分别于术后6个月和7个月死于该疾病。
对于局部晚期胆囊癌且疾病进展至pN2期之前、若潜在根治性切除可行的选定患者，伴有广泛淋巴结清扫的肝胰十二指肠切除术是一种有效的治疗方法。对于pM1（淋巴）期疾病患者，不建议进行手术。
