Nishio Hideki, Nagino Masato, Ebata Tomoki, Yokoyama Yukihiro, Igami Tsuyoshi, Nimura Yuji
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Hepatobiliary Pancreat Surg. 2007;14(4):351-7. doi: 10.1007/s00534-006-1187-0. Epub 2007 Jul 30.
BACKGROUND/PURPOSE: Advanced gallbladder carcinoma with paraaortic lymph node metastasis or distant metastasis is normally considered a contraindication for surgery. Our latest analyses suggest otherwise.
Records of 166 patients who underwent surgery for stage IV gallbladder carcinoma were reviewed retrospectively. Predictors of hospital mortality and long-term survival were analyzed. Long-term survival in patients with paraaortic lymph node metastasis and/or distant metastasis was also determined.
Fifteen patients were 5-year survivors, with a 5-year survival rate of 12% among the 166 patients investigated. Overall hospital mortality was 14%. Male sex and portal vein resection were independent predictors of hospital mortality. Multivariate analysis of long-term survival failed to identify independent predictors. Patients with distant metastasis were divided into two groups based on whether or not the metastases were distant from the liver. Patients with paraaortic lymph node metastasis who underwent curative resection or who had isolated liver metastasis survived longer than those with other distant metastasis or those with unresectable advanced cancer.
Patients with advanced gallbladder carcinoma can benefit from surgical resection even when paraaortic lymph node metastasis and/or liver metastasis are present. However, surgical indications in advanced disease should be determined on an individual basis, based on clinical status.
背景/目的：伴有主动脉旁淋巴结转移或远处转移的晚期胆囊癌通常被视为手术禁忌证。但我们最新的分析结果却并非如此。
回顾性分析了166例接受IV期胆囊癌手术患者的病历。分析了医院死亡率和长期生存的预测因素。还确定了伴有主动脉旁淋巴结转移和/或远处转移患者的长期生存率。
15例患者存活了5年，在166例被调查患者中5年生存率为12%。总体医院死亡率为14%。男性和门静脉切除是医院死亡率的独立预测因素。对长期生存的多因素分析未能确定独立的预测因素。远处转移患者根据转移灶是否远离肝脏分为两组。接受根治性切除或孤立性肝转移的主动脉旁淋巴结转移患者比其他远处转移患者或不可切除的晚期癌症患者存活时间更长。
即使存在主动脉旁淋巴结转移和/或肝转移，晚期胆囊癌患者也可从手术切除中获益。然而，晚期疾病的手术适应证应根据临床状况个体化确定。
