Sikora Sadiq S, Singh Rajneesh K
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Surg Oncol. 2006 Jun 15;93(8):670-81. doi: 10.1002/jso.20535.
Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer.
Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease.
Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few.
Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity.
胆囊癌是一种侵袭性疾病，手术治疗效果不佳，预后较差。然而，在过去几十年中，部分研究组报告称，积极手术治疗胆囊癌可取得更好的效果。
对近期世界文献进行综述，以更新该疾病手术治疗的当前概念。
早期胆囊癌有可能实现长期生存。Tis和T1a期胆囊癌仅行单纯胆囊切除术即可。然而，对于T1b期及以上的癌症，积极手术（扩大胆囊切除术）对于改善长期预后至关重要。由于常与可能导致癌细胞种植和播散的因素（如胆囊穿孔和胆汁外溢）相关，对于高度怀疑恶性肿瘤的情况不应进行腹腔镜胆囊切除术。仅当有可能实现根治性R0切除时，才建议对晚期胆囊癌进行手术切除。尽管死亡率和发病率有所增加，但已证明进行血管和多脏器切除的积极手术是可行的。然而，由于晚期胆囊癌的长期存活者实际数量很少，这些根治性切除的真正益处尚未实现。
与其他恶性肿瘤一样，胆囊癌手术仅在局部或区域疾病中有可能治愈。疾病的局部区域扩散模式决定了手术方式。根治性手术可提高早期胆囊癌的生存率。对于晚期疾病进行积极手术的长期益处尚不清楚，且可能被高死亡率和发病率所抵消。
