Kohya Naohiko, Miyazaki Kohji
Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
J Surg Oncol. 2008 May 1;97(6):498-502. doi: 10.1002/jso.20982.
The prognosis of advanced gallbladder carcinoma (GBCa) remains unfortunate. However, the prognostic factors and the efficacy of extended resection remain unclear. The adequacy for extended resection for T2 and T3 GB Ca, according to the characteristics of either the clinicopathological factors or the prognostic factors, was evaluated.
A series of 73 patients with GBCa were treated after 1989. Tumor staging from the AJCC revealed 23 patients with T2 tumors, and 29 patients with T3 tumors, respectively.
For T2 GB Ca, the patient group of extra-hepatic bile duct resection (BDR) and the patient group of S4a + 5 hepatectomy S4a + 5 had significantly better survival rates. For T3 GB Ca, the patient group of BDR and S4a + 5 tend to have better survival rates. For both T2 and T3 GB Ca, either pancreatoduodenectomy (PD) or pylorus-preserving pancreatoduodenectomy (PpPD) showed no significant difference in survival.
S4a + 5 combined with BDR and D2 lymph node dissection is a highly recommended operation for the treatment of T2 and T3 GB Ca. Further extension of the operation, such as the addition of PD (PpPD) or an extended hepatectomy, should be carefully modified for each individual according to the cancer spread mode.
晚期胆囊癌（GBCa）的预后仍然不容乐观。然而，预后因素以及扩大切除术的疗效仍不明确。根据临床病理因素或预后因素的特征，评估了T2和T3期胆囊癌扩大切除术的充分性。
1989年以后对一系列73例GBCa患者进行了治疗。美国癌症联合委员会（AJCC）的肿瘤分期显示，分别有23例T2期肿瘤患者和29例T3期肿瘤患者。
对于T2期胆囊癌，肝外胆管切除术（BDR）患者组和S4a+5肝切除术患者组的生存率明显更高。对于T3期胆囊癌，BDR和S4a+5患者组的生存率往往更高。对于T2和T3期胆囊癌，胰十二指肠切除术（PD）或保留幽门的胰十二指肠切除术（PpPD）在生存率方面均无显著差异。
S4a+5联合BDR和D2淋巴结清扫术是治疗T2和T3期胆囊癌的高度推荐手术。手术的进一步扩大，如增加PD（PpPD）或扩大肝切除术，应根据癌症的扩散方式对每个个体进行仔细调整。
