Onoe Shunsuke, Kaneoka Yuji, Maeda Atsuyuki, Takayama Yuichi, Fukami Yasuyuki, Isogai Masatoshi
Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan,
Updates Surg. 2015 Sep;67(3):265-71. doi: 10.1007/s13304-015-0319-y. Epub 2015 Aug 19.
The results of surgical treatment for T2 gallbladder carcinoma are equivocal, while the precise preoperative TNM staging and localization of gallbladder carcinoma are difficult. The aim of this study was to report the validity of segment 4b and 5 (S4b+5) hepatectomy with extrahepatic bile duct resection for these tumors. We reviewed 30 patients with pT2 gallbladder cancer who underwent S4b+5 hepatectomy with extrahepatic bile duct resection. The median number of lymph nodes retrieved in the S4b+5 hepatectomy group was 11 (0-23) nodes, and lymph node metastasis was observed in 9 of 30 (30%) cases. Although all surgical margins were macroscopically negative, 4 of the 30 patients (13%) had pathologically positive margins. The overall survival rate of patients was 85.1% at 5 years. Of the 30 patients with S4b+5 hepatectomy, surgical margin alone was analyzed as a prognostic factor in univariate and multivariate analysis. The survival rate was comparable between the tumor on the hepatic side and peritoneal side (P = 0.856). Nine patients with additional S4b+5 hepatectomy after simple cholecystectomy because of incidental diagnosis of gallbladder cancer also had comparable survival compared to the remaining 21 patients with simultaneous S4b+5 hepatectomy (P = 0.624). S4b+5 hepatectomy with extrahepatic bile duct resection could be good treatment modality for T2 gallbladder cancers because precise preoperative diagnosis of tumor depth, location, and lymph node metastasis for these tumors is difficult.
T2期胆囊癌的手术治疗结果尚无定论，而胆囊癌术前精确的TNM分期和定位也很困难。本研究的目的是报告对这些肿瘤行4b和5段（S4b+5）肝切除术联合肝外胆管切除术的有效性。我们回顾了30例行S4b+5肝切除术联合肝外胆管切除术的pT2期胆囊癌患者。S4b+5肝切除术组切除淋巴结的中位数为11枚（0-23枚），30例中有9例（30%）观察到淋巴结转移。尽管所有手术切缘肉眼观均为阴性，但30例患者中有4例（13%）病理切缘阳性。患者5年总生存率为85.1%。在30例行S4b+5肝切除术的患者中，单因素和多因素分析仅将手术切缘作为预后因素。肝侧和腹膜侧肿瘤的生存率相当（P = 0.856）。9例因胆囊癌偶然诊断在单纯胆囊切除术后追加S4b+5肝切除术的患者与其余21例同期行S4b+5肝切除术的患者生存率也相当（P = 0.624）。对于T2期胆囊癌，行S4b+5肝切除术联合肝外胆管切除术可能是一种较好的治疗方式，因为对这些肿瘤的肿瘤深度、位置和淋巴结转移进行术前精确诊断很困难。
