胆囊癌根治性手术：生存可能性
Radical surgery for gallbladder carcinoma: possibilities of survival.
作者信息
Principe Alfonso, Del Gaudio Massimo, Ercolani Giorgio, Golfieri Rita, Cucchetti Alessandro, Pinna Antonio Daniele
机构信息
Department of Surgery and Transplantation, University of Bologna, S Orsola-Malpighi Hospital, Italy.
出版信息
Hepatogastroenterology. 2006 Sep-Oct;53(71):660-4.
BACKGROUND/AIMS: An aggressive surgical approach in the management of gallbladder cancer (GBC) has improved survival significantly in recent years. The aim of this retrospective study is to evaluate the long-term results of surgical treatment of GBC reassessed following the TNM staging system of the AJCC-2002.
METHODOLOGY
The present series considers 118 patients with GBC treated between 1982 and 2003. Seventy-four cases (63%) were females and 44 (37%) males; overall age was 63 years (range 38-91).
RESULTS
Among the 118 patients with GBC, 35 (36%) underwent radical surgery: 3 pTNM IA [3 cholecystectomy (CT)], 10 IB [3CT, 3 CT + hepatic resection (HR), 4 HR], 3 IIA (3 HR), 7 IIB (3 CT+HR+ bile duct resection (BDR), 3 HR, 1 hepatopancreatoduodenectomy +CT), 10 III [4 CT+HR, 5 extensive HR (eHR), 1 HR+right colectomy+BDR+total gastrectomy], 2 IV (2 eHR). Overall 1-, 3-, 5-year survival was 67%, 46%, 34% respectively for stage IA-IB; 63%,12%, 12% for IIA-IIB; 50%, 30%, 30% for III-IV (p=ns); in particular, 1-, 3-, 5-year survival was 100%, 100%, 100% for T1a; 50%, 50%, 50% for T1b; 70%, 46%, 35% for T2; 50%, 12%, 12% for T3; 54%, 32%, 32% for T4 (p=ns); 1-, 3-, 5-year survival for patients without lymph node involvement was 58%, 44%, 37% and 60%, 15%, 15% for patients with lymph node metastases (p=ns), respectively.
CONCLUSIONS
CT seems to be sufficient in T1a GBC patients but inadequate in T1b (stage IA), which requires a more aggressive approach. In stage IIB, III and IV, the presence of lymph-node metastasis is not a contraindication to aggressive surgery.
背景/目的：近年来，在胆囊癌（GBC）的治疗中采用积极的手术方法显著提高了生存率。本回顾性研究的目的是根据美国癌症联合委员会（AJCC）2002年的TNM分期系统重新评估GBC手术治疗的长期结果。
方法
本系列研究纳入了1982年至2003年间接受治疗的118例GBC患者。74例（63%）为女性，44例（37%）为男性；总体年龄为63岁（范围38 - 91岁）。
结果
在118例GBC患者中，35例（36%）接受了根治性手术：3例pTNM IA期[3例行胆囊切除术（CT）]，10例IB期[3例CT，3例CT + 肝切除术（HR），4例HR]，3例IIA期（3例HR），7例IIB期（3例CT + HR + 胆管切除术（BDR），3例HR，1例肝胰十二指肠切除术 + CT），10例III期[4例CT + HR，5例广泛肝切除术（eHR），1例HR + 右半结肠切除术 + BDR + 全胃切除术]，2例IV期（2例eHR）。IA - IB期患者的1年、3年、5年总生存率分别为67%、46%、34%；IIA - IIB期为63%、12%、12%；III - IV期为50%、30%、30%（p值无统计学意义）；具体而言，T1a期患者的1年、3年、5年生存率为100%、100%、100%；T1b期为50%、50%、50%；T2期为70%、46%、35%；T3期为50%、12%、12%；T4期为54%、32%、32%（p值无统计学意义）；无淋巴结转移患者的1年、3年、5年生存率分别为58%、44%、37%，有淋巴结转移患者为60%、15%、15%（p值无统计学意义）。
结论
对于T1a期GBC患者，CT似乎足够，但对于T1b期（IA期）则不足，这需要更积极的手术方法。在IIB期、III期和IV期，存在淋巴结转移并非积极手术的禁忌证。
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