Igami Tsuyoshi, Ebata Tomoki, Yokoyama Yukihiro, Sugawara Gen, Mizuno Takashi, Yamaguchi Junpei, Shimoyama Yoshie, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
World J Surg. 2015 Jul;39(7):1810-7. doi: 10.1007/s00268-015-3011-y.
Prophylactic combined extrahepatic bile duct resection remains controversial for locally advanced gallbladder carcinoma without extrahepatic bile duct invasion. The aim of this study is to resolve this issue and establish an appropriate surgery for locally advanced gallbladder carcinoma.
A total of 52 patients underwent surgical resection combined with extrahepatic bile duct resection for locally advanced gallbladder carcinoma without extrahepatic bile duct invasion, and their medical records were retrospectively reviewed for microvessel invasion (MVI), including lymphatic, venous, and/or perineural invasions, around the extrahepatic bile duct.
Of the 52 patients, 8 (15 %) had MVI around the extrahepatic bile duct. All of the 8 patients had Stage IV disease. According to a survival analysis of the 50 patients who tolerated surgery, MVIs around the extrahepatic bile duct and distant metastasis were identified as independent prognostic factors. Survival for patients with MVI around the extrahepatic bile duct was dismal, with a lack of 2-year survivors.
MVI around the extrahepatic bile duct is a sign of extremely locally advanced gallbladder carcinoma; therefore, prophylactic combined bile duct resection has no survival impact for patients without extrahepatic bile duct invasion.
对于无肝外胆管侵犯的局部进展期胆囊癌，预防性联合肝外胆管切除术仍存在争议。本研究的目的是解决这一问题，并为局部进展期胆囊癌建立合适的手术方式。
共有52例无肝外胆管侵犯的局部进展期胆囊癌患者接受了手术切除联合肝外胆管切除术，并对其病历进行回顾性分析，以评估肝外胆管周围的微血管侵犯（MVI）情况，包括淋巴管、静脉和/或神经周围侵犯。
52例患者中，8例（15%）肝外胆管周围存在MVI。这8例患者均为IV期疾病。根据对50例耐受手术患者的生存分析，肝外胆管周围的MVI和远处转移被确定为独立的预后因素。肝外胆管周围存在MVI的患者生存率极低，无2年生存者。
肝外胆管周围的MVI是局部进展期胆囊癌的标志；因此，对于无肝外胆管侵犯的患者，预防性联合胆管切除术对生存无影响。
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