Lee Huisong, Choi Dong Wook, Park Jin Young, Youn Sangmin, Kwon Wooil, Heo Jin Seok, Choi Seong Ho, Jang Kee-Taek
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Oncol. 2015 Aug;22(8):2779-86. doi: 10.1245/s10434-014-4300-7. Epub 2014 Dec 18.
Radical cholecystectomy is recommended for T2 gallbladder cancer. However, it is unclear whether hepatic resection is essential for peritoneal-side gallbladder cancer.
From January 2000 to December 2011, we identified T2 gallbladder cancer patients who had undergone curative intent surgery. A peritoneal-side tumor was defined when the epicenter of the tumor was located within the free peritoneal-side gallbladder mucosa. Hepatic-side gallbladder cancer was defined when the epicenter of the tumor was located within the gallbladder bed or neck.
A total of 157 patients with T2 gallbladder cancer were included; 33 peritoneal-side and 124 hepatic-side tumors. In total, 122 patients underwent hepatic resection, whereas the remaining 35 patients did not. After a median follow-up period of 40 (range 5-170) months, the survival of the peritoneal-side group was better than that of the hepatic-side group (p = 0.002). In a multivariate analysis, tumor location, lymph node metastasis, hepatic resection, lymphatic invasion, and perineural invasion were significant prognostic factors (p = 0.045, p < 0.001, p = 0.003, p = 0.046, and p = 0.027, respectively). For the peritoneal-side group, there was no recurrence or death after cholecystectomy without hepatic resection. However, hepatic resection was an important factor associated with overall survival in patients with hepatic-side gallbladder cancer (p = 0.007).
In T2 gallbladder cancer patients, hepatic resection is recommended when there is tumor invasion of the gallbladder bed or neck. However, it is not always necessary in selected patients with peritoneal-side gallbladder cancer.
对于T2期胆囊癌，推荐行根治性胆囊切除术。然而，对于侵犯胆囊壁全层的胆囊癌，肝切除术是否必要尚不清楚。
2000年1月至2011年12月期间，我们纳入了接受根治性手术的T2期胆囊癌患者。当肿瘤中心位于胆囊游离壁黏膜层时，定义为侵犯胆囊壁全层的肿瘤。当肿瘤中心位于胆囊床或胆囊颈部时，定义为侵犯肝床的胆囊癌。
共纳入157例T2期胆囊癌患者；其中侵犯胆囊壁全层的肿瘤33例，侵犯肝床的肿瘤124例。总共有122例患者接受了肝切除术，其余35例患者未接受肝切除术。中位随访期为40（5 - 170）个月，侵犯胆囊壁全层组的生存率高于侵犯肝床组（p = 0.002）。多因素分析显示，肿瘤位置、淋巴结转移、肝切除术、淋巴管侵犯和神经周围侵犯是显著的预后因素（p分别为0.045、<0.001、0.003、0.046和0.027）。对于侵犯胆囊壁全层组，未行肝切除术的患者在胆囊切除术后无复发或死亡。然而，肝切除术是侵犯肝床的胆囊癌患者总生存的重要相关因素（p = 0.007）。
在T2期胆囊癌患者中，当肿瘤侵犯胆囊床或颈部时，推荐行肝切除术。然而，对于部分侵犯胆囊壁全层的胆囊癌患者，肝切除术并非总是必要的。
