World J Surg. 2013 Nov;37(11):2635-40. doi: 10.1007/s00268-013-2187-2.
Incidental findings of gallbladder cancer (GBCA) have dramatically increased as an initial presentation of the disease because of the expansion of laparoscopic cholecystectomy. However, the optimal management of T2 GBCA remains at issue.
We compared our 10-year experience with the consensus surgical strategy for T2 GBCA. Between January 2000 and December 2009, 70 patients at Severance Hospital, Yonsei University Health System, Seoul, Korea, underwent surgical treatment for GBCA stage T2. The medical records of 70 patients with T2 GBCA were retrospectively reviewed.
Radical cholecystectomy was performed on only 32 (45.8 %) patients. In patients with T2 GBCA and positive lymph nodes (LN), the overall survival rate between cholecystectomy with LN dissection and radical cholecystectomy did not show a significant difference. Twenty patients experienced recurrence during the follow-up period. Among the 11 patients who underwent cholecystectomy with liver resection, only 2 (18.2 %) patients had an intrahepatic recurrence. Of the 9 patients who underwent cholecystectomy without liver resection, 3 (33.3 %) patients had an intrahepatic recurrence. However, recurrences at the gallbladder bed occurred only in one and two patients, respectively, and were not significantly different between the two groups.
There was a large gap between clinical practice and treatment guidelines. Though relatively few patients enrolled in this study experienced recurrence, cholecystectomy and LN dissection without liver resection showed similar survival and recurrence patterns compared with those of radical cholecystectomy. To improve consistency between clinical practice and consensus guidelines, the role of limited resection for T2 lesions needs further evaluation.
由于腹腔镜胆囊切除术的广泛开展，胆囊癌（GBCA）的偶然发现作为该病的初始表现显著增加。然而，T2 GBCA 的最佳治疗方法仍存在争议。
我们比较了我们 10 年的经验与 T2 GBCA 的共识手术策略。在 2000 年 1 月至 2009 年 12 月期间，韩国首尔延世大学健康系统塞弗伦斯医院对 70 例 GBCA 分期 T2 的患者进行了手术治疗。回顾性分析了 70 例 T2 GBCA 患者的病历。
仅对 32 例（45.8%）患者进行了根治性胆囊切除术。在 T2 GBCA 合并阳性淋巴结（LN）的患者中，胆囊切除术加 LN 清扫术与根治性胆囊切除术之间的总生存率无显著差异。20 例患者在随访期间复发。在接受胆囊切除术加肝切除术的 11 例患者中，仅 2 例（18.2%）患者出现肝内复发。在 9 例未行肝切除术的患者中，3 例（33.3%）患者出现肝内复发。然而，胆囊床复发仅分别发生在 1 例和 2 例患者中，两组之间无显著差异。
临床实践与治疗指南之间存在较大差距。尽管本研究中纳入的患者复发相对较少，但胆囊切除术加 LN 清扫术而不进行肝切除术与根治性胆囊切除术具有相似的生存和复发模式。为了使临床实践与共识指南之间更加一致，需要进一步评估 T2 病变的有限切除术的作用。
