Muratore Andrea, Amisano Marco, Viganò Luca, Massucco Paolo, Capussotti Lorenzo
Department of Surgical Oncology, Istituto per la Ricerca e la Cura del Cancro, Candiolo (TO), Italy.
J Surg Oncol. 2003 Aug;83(4):212-5. doi: 10.1002/jso.10258.
Most T2 gallbladder cancers are diagnosed at final pathology after cholecystectomy. Reoperations including liver resection and regional lymph node dissection are needed to achieve better long-term results. The aim of this study is to evaluate long-term results of reresections after prior non-curative surgery for T2 carcinomas.
Retrospective study from January 1985 to July 2001. Twelve out of 14 pT2 cancers were found postoperatively. All but one underwent reresection: these 11 patients are the basis of our series.
The in-hospital mortality rate was 0%. Overall 5-year survival was 63.5% with a median survival of 25 months. Median and 5-year survival of the eight cases without preoperative signs of disease (Group A) were 46.7 months and 100%. These results were significantly better than those obtained in the subset (Group B: three cases) with preoperative signs of disease (P = 0.01): all these patients died of recurrence within 25 months from the reoperation. Mean time between cholecystectomy and reresection was 2.2 and 11.3 months in the Group A and B (P = 0.01), respectively.
T2 cancers discovered incidentally after simple cholecystectomy should be reoperated on as soon as possible, as the appearance, before reoperation, of a recurrence is significantly related to a dismal prognosis.
大多数T2期胆囊癌在胆囊切除术后的最终病理检查中被诊断出来。为了获得更好的长期效果，需要进行包括肝切除和区域淋巴结清扫在内的再次手术。本研究的目的是评估T2期癌先前非根治性手术后再次手术的长期效果。
对1985年1月至2001年7月进行回顾性研究。14例pT2癌中有12例在术后发现。除1例患者外，其余均接受了再次手术：这11例患者是我们系列研究的基础。
住院死亡率为0%。总体5年生存率为63.5%，中位生存期为25个月。8例无术前疾病迹象的患者（A组）的中位生存期和5年生存率分别为46.7个月和100%。这些结果明显优于有术前疾病迹象的亚组（B组：3例）（P = 0.01）：所有这些患者在再次手术后25个月内均死于复发。A组和B组胆囊切除与再次手术之间的平均时间分别为2.2个月和11.3个月（P = 0.01）。
单纯胆囊切除术后偶然发现的T2期癌应尽快进行再次手术，因为再次手术前出现复发与预后不良显著相关。
