Pottakkat Biju, Kapoor Abhimanyu, Prakash Anand, Singh Rajneesh Kumar, Behari Anu, Kumar Ashok, Kapoor Vinay K, Saxena Rajan
Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226014, UP, India.
J Gastrointest Cancer. 2013 Mar;44(1):33-40. doi: 10.1007/s12029-012-9432-z.
Radical resection to achieve R0 status remains the only potential curative option in patients with gall bladder cancer (GBC). This study was aimed to evaluate the efficacy of an extended criterion of radical resection to achieve R0 status in GBC.
A triple-phase CT with 3D reconstruction was done in all patients. A standard resectability criterion was followed in all patients. A minimum of liver segment 4B + 5 resection and radical lymphadenectomy including the para-aortic areas were undertaken in all patients. Adjacent organectomy was added as required.
Between November 2008 and April 2011, 59 patients with GBC underwent operation and 40 (resectability, 68 %) underwent resection. The resectional procedures performed were segmentectomy 4B + 5 in 31 (78 %), median sectorectomy in 2 (5 %), extended right hepatectomy in 3 (8 %), and hepatopancreaticoduodenectomy in 4 (10 %) patients. Postoperative complications occurred in 24 (60 %) patients. Two patients died postoperatively. A total of 829 lymph nodes were harvested and the median lymph node count was 18 (4-77). Twenty-three (58 %) patients had lymph node metastases. Twenty-eight of 40 (70 %) had disease limited till N1 nodes. Metastases up to N2 lymph nodes were seen in 12 (30 %). American Joint Committee on Cancer seventh edition stages were I-2 (5 %) patients, II-5 (13 %), III-19 (48 %), and IV-14 (35 %). R0 resection was achieved in 33 (83 %) patients. Four patients had recurrence and one died of recurrence. All other patients are alive till the last follow-up.
Assessment with triple-phase CT with 3D reconstruction can produce high resectability rate in GBC. Extended criterion of radical resection results in R0 status in more than 80 % of patients with GBC.
根治性切除以达到R0状态仍然是胆囊癌（GBC）患者唯一可能的治愈选择。本研究旨在评估扩大根治性切除标准以在GBC中实现R0状态的疗效。
对所有患者进行了带有三维重建的三期CT检查。所有患者均遵循标准的可切除性标准。所有患者均至少进行肝4B段+5段切除及包括主动脉旁区域在内的根治性淋巴结清扫术。根据需要进行相邻器官切除术。
2008年11月至2011年4月期间，59例GBC患者接受了手术，40例（可切除率68%）接受了切除术。实施的切除手术包括31例（78%）的4B+5段切除术、2例（5%）的正中肝段切除术、3例（8%）的扩大右肝切除术以及4例（10%）的肝胰十二指肠切除术。24例（60%）患者发生术后并发症。2例患者术后死亡。共采集了829枚淋巴结，中位淋巴结数量为18枚（4 - 77枚）。23例（58%）患者有淋巴结转移。40例中的28例（70%）疾病局限于N1期淋巴结。12例（30%）可见N2期淋巴结转移。美国癌症联合委员会第七版分期为I期2例（5%）、II期5例（13%）、III期19例（48%）、IV期14例（35%）。33例（83%）患者实现了R0切除。4例患者复发，1例死于复发。所有其他患者在最后一次随访时均存活。
采用带有三维重建的三期CT评估可使GBC的可切除率较高。扩大的根治性切除标准可使超过80%的GBC患者达到R0状态。
