Scheingraber Stefan, Justinger Christoph, Stremovskaia Tatiana, Weinrich Malte, Igna Dorian, Schilling Martin K
Department of General-, Visceral-, Vascular- and Paediatric Surgery, University Hospital, University of the Saarland, D-66421 Homburg, Germany.
World J Surg Oncol. 2007 May 21;5:55. doi: 10.1186/1477-7819-5-55.
The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer.
The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation.
Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014). The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct.
Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.
本研究的目的是调查过去12年中接受胆囊癌治疗的患者的手术程序范围、病理结果、并发症及预后情况。
将标准化的更积极治疗方法与本中心过去采用个体化治疗方法的对照组进行对比研究。在53例患者中，21例行根治性切除术，32例行姑息性切除术。
总体医院死亡率为9%，与手术相关的死亡率为4%。与采用个体化治疗方法的患者相比，UICC分期为IIa、IIb和III期的患者采用标准化治疗方法后预后显著改善（中位生存期：14个月对7个月，平均±标准误：26±7个月对17±5个月，p = 0.014）。标准化治疗方法与个体化治疗方法的主要差异在于解剖性肝切除术与非典型肝切除术、肝十二指肠韧带系统性淋巴结清扫以及胆总管切除术。
解剖性肝切除术、胆管浸润的证据以及在肿瘤侵犯时进行根治性切除和肝十二指肠韧带淋巴结清扫对于改善局部晚期胆囊癌的预后至关重要。
