Ishihara Shin, Miyakawa Shuichi, Takada Tadahiro, Takasaki Ken, Nimura Yuji, Tanaka Masao, Miyazaki Masaru, Nagakawa Takukazu, Kayahara Masato, Horiguchi Akihiko
Department of Biliary Pancreatic Surgery, Fujita Health University, Toyoake, Japan.
Dig Surg. 2007;24(2):131-6. doi: 10.1159/000101901. Epub 2007 Apr 19.
Complete surgical resection of biliary tract carcinoma remains the best treatment. The Japanese Society of Biliary Surgery has organized a registry project and established a classification of biliary tract carcinoma. We report here the status of biliary surgery in Japan. For hilar bile duct carcinoma, major hepatectomy is needed to increase the resection rate, and total caudate lobectomy is required for curative resection. The 5-year survival rate was 39.1%. Middle and distal bile duct carcinomas were treated with pancreatoduodenectomy (PD) or pylorus-preserving PD (PPPD) or bile duct resection alone. The 5-year survival rate was 44.0%. The treatment of gallbladder carcinoma with pT1 lesions is cholecystectomy. The treatment of pT2 lesions is extended cholecystectomy or various hepatectomy with or without extrahepatic bile duct resection along with lymphadenectomy. Treatment of pT3 and pT4 lesions includes hepatectomy with or without bile duct resection, combined with vascular resection, extended lymphadenectomy, and autonomic nerve dissection. Several groups in Japan have performed hepatopancreatoduodenectomy. The 5-year survival rate of pT1, pT2, pT3, and pT4 were 93.7, 65.1, 27.3, and 13.8%. PD or PPPD is the standard operation for carcinoma of the papilla of Vater. The 5-year survival rate was 57.5%.
完整切除胆道癌仍然是最佳治疗方法。日本胆道外科学会组织了一项登记项目并建立了胆道癌分类。我们在此报告日本的胆道手术现状。对于肝门部胆管癌，需要进行扩大肝切除术以提高切除率，而根治性切除则需要行全尾状叶切除术。5年生存率为39.1%。中、远端胆管癌采用胰十二指肠切除术（PD）或保留幽门的胰十二指肠切除术（PPPD）或单纯胆管切除术治疗。5年生存率为44.0%。pT1期胆囊癌的治疗方法是胆囊切除术。pT2期病变的治疗是扩大胆囊切除术或各种肝切除术，可伴或不伴肝外胆管切除及淋巴结清扫。pT3和pT4期病变的治疗包括肝切除术，可伴或不伴胆管切除，联合血管切除、扩大淋巴结清扫和自主神经清扫。日本有几个团队开展了肝胰十二指肠切除术。pT1、pT2、pT3和pT4期的5年生存率分别为93.7%、65.1%、27.3%和13.8%。PD或PPPD是 Vater 乳头癌的标准手术方式。5年生存率为57.5%。
