Lai C H Eric, Lau W Y
Department of Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Surgeon. 2008 Apr;6(2):101-10. doi: 10.1016/s1479-666x(08)80073-x.
Gallbladder cancer is the fifth most common cancer involving the gastrointestinal tract, but it is the most common malignant tumour of the biliary tract worldwide. The percentage of patients diagnosed to have gallbladder cancer after simple cholecystectomy for presumed gallbladder stone disease is 0.5-1.5%. This tumour is traditionally regarded as a highly lethal disease with an overall 5-year survival of less than 5%. The marked improvement in the outcome of patients with gallbladder cancer in the last decade is because of the aggressive radical surgical approach that has been adopted, and improvements in surgical techniques and peri-operative care. This article aims to review the current approach to the management of gallbladder cancer.
A Medline, PubMed database search was performed to identify articles published from 1990 to 2007 using the keywords 'carcinoma of gallbladder', 'gallbladder cancer', 'gallbladder neoplasm' and 'cholecystectomy'.
The overall 5-year survival for patients with gallbladder cancer who underwent Ro curative resection was reported to range from 21% to 69%. Laparoscopic cholecystectomy is absolutely contraindicated when gallbladder cancer is known or suspected pre-operatively. Patients with a pre-operative suspicion of gallbladder cancer should undergo open exploration and cholecystectomy after proper pre-operative assessment. For patients whose cancer is an incidental finding on pathological review, a second radical resection is indicated except for Tis and T1a disease. There is still controversy for the optimal management of T1b disease. Although the role of surgery for advanced disease remains controversial, patients with advanced gallbladder cancer can benefit from radical resection, provided a potentially curative Ro resection is possible. There is still no effective adjuvant therapy for gallbladder cancer.
胆囊癌是胃肠道中第五大常见癌症，但在全球范围内是胆道最常见的恶性肿瘤。因推测为胆囊结石疾病而接受单纯胆囊切除术后被诊断为胆囊癌的患者比例为0.5 - 1.5%。传统上，这种肿瘤被视为一种高致死性疾病，总体5年生存率低于5%。过去十年中胆囊癌患者预后的显著改善归因于所采用的积极根治性手术方法、手术技术及围手术期护理的改进。本文旨在综述当前胆囊癌的治疗方法。
利用关键词“胆囊癌”“胆囊癌症”“胆囊肿瘤”和“胆囊切除术”，对1990年至2007年发表在Medline、PubMed数据库中的文章进行检索。
据报道，接受R0根治性切除术的胆囊癌患者总体5年生存率在21%至69%之间。如果术前已知或怀疑胆囊癌，腹腔镜胆囊切除术绝对禁忌。术前怀疑胆囊癌的患者应在进行适当的术前评估后接受开放探查及胆囊切除术。对于病理检查偶然发现癌症的患者，除Tis和T1a期疾病外，均需进行二次根治性切除。对于T1b期疾病的最佳治疗仍存在争议。尽管手术在晚期疾病中的作用仍存在争议，但晚期胆囊癌患者若有可能进行潜在根治性的R0切除，则可从根治性切除中获益。目前仍没有有效的胆囊癌辅助治疗方法。
