Nakata Takenari, Kobayashi Akira, Miwa Shiro, Soeda Junpei, Uehara Takeshi, Miyagawa Shinichi
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(1):75-82. doi: 10.1007/s00534-008-0008-z. Epub 2008 Dec 19.
According to Farrar's criteria, a tumor restricted to the cystic duct is defined as cystic duct carcinoma, but this definition excludes advanced carcinoma originating from the cystic duct.
For the purpose of this study, primary cystic duct carcinoma was defined as a tumor originating from the cystic duct. We investigated the clinicopathological features of 15 cystic duct carcinomas, including 13 that did not fit Farrar's criteria, and compared them with those of 52 cases of gallbladder carcinoma and 161 cases of extrahepatic bile duct carcinoma.
The incidence of primary cystic duct carcinoma was 6.6% among all malignant biliary tumors. The main symptom was jaundice in 67% of cases. The operative procedures employed ranged from cholecystectomy to hepatopancreatoduodenectomy. The cases of cystic duct carcinoma and bile duct carcinoma showed a high frequency of perineural infiltration. The overall 5-year survival rate of the 15 patients was 40%.
Patients with advanced cystic duct carcinoma show a high frequency of jaundice and perineural infiltration. Our data suggest that cystic duct carcinoma may be considered a distinct subgroup of gallbladder carcinoma. Radical surgery is necessary for potentially curative resection in patients with advanced cystic duct carcinoma.
根据法勒标准，局限于胆囊管的肿瘤被定义为胆囊管癌，但该定义排除了起源于胆囊管的进展期癌。
在本研究中，原发性胆囊管癌被定义为起源于胆囊管的肿瘤。我们调查了15例胆囊管癌的临床病理特征，其中13例不符合法勒标准，并将其与52例胆囊癌和161例肝外胆管癌的临床病理特征进行了比较。
在所有恶性胆管肿瘤中，原发性胆囊管癌的发生率为6.6%。67%的病例主要症状为黄疸。所采用的手术方式从胆囊切除术到肝胰十二指肠切除术不等。胆囊管癌和胆管癌病例神经周围浸润的发生率较高。15例患者的总体5年生存率为40%。
进展期胆囊管癌患者黄疸和神经周围浸润的发生率较高。我们的数据表明，胆囊管癌可能被视为胆囊癌的一个独特亚组。对于进展期胆囊管癌患者，根治性手术对于可能的根治性切除是必要的。
