Singh Santosh Kumar, Talwar Rajnish, Kannan Narayanan, Tyagi Arvind Kumar, Jaiswal Pradeep, Kumar Adarsh
Army Hospital (Research & Referral), New Delhi, 10, India.
J Gastrointest Cancer. 2015 Dec;46(4):399-407. doi: 10.1007/s12029-015-9766-4.
Gallbladder cancer (GBC) is an aggressive disease with dismal results of surgical treatment mainly because of advanced stage at presentation. The objective of this study was to investigate whether aggressive surgical treatment can be associated with reasonable survival for patients with GBC at acceptable morbidity and mortality.
A total of 113 patients with proven or presumptive diagnosis of GBC were recruited prospectively over a period of 2 years and evaluated for diagnosis and staging by appropriate investigations. Seven out of 113 patients were found to have benign pathology either intraoperatively or on histopathological examination hence excluded from follow-up and survival analysis. Out of 32 potentially resectable patients, only 21 patients could finally be resected with curative intent. Patients found unresectable/metastatic disease intraoperatively (n = 11) were treated with palliative chemotherapy if eligible for the same. Short-term morbidity, perioperative mortality, disease-free survival (DFS), and median overall survival (OS) of surgically resected patients were analyzed. Median OS of resected patients was compared with that of unresectable patients.
Overall resectability rate in this study cohort was 19.8 % (21/106). Overall mortality was 4.7 % and morbidity was 42.8 %. Stage distribution of resected patients was as follows: stage II (3), stage IIIA (9), stage IIIB (8), and stage IVA (1). DFS at 12 and 18 months was found to be 82.5 and 73.3 %, respectively. Mean DFS was 19.9 months (SE 1.42, 95 % CI). Mean OS for resected patients was 21 months and that for unresectable patients was 11.3 months only. Both groups were compared using log rank (Mantel-cox) test and statistically significant difference in OS was observed (p value <0.0001).
Since curative resection is the only chance of cure, aggressive surgical approach adopted by us is justified with acceptable mortality and morbidity and encouraging overall survival.
胆囊癌（GBC）是一种侵袭性疾病，手术治疗效果不佳，主要原因是就诊时已处于晚期。本研究的目的是探讨积极的手术治疗是否能在可接受的发病率和死亡率情况下，使GBC患者获得合理的生存期。
在2年的时间里前瞻性招募了总共113例经证实或疑似诊断为GBC的患者，并通过适当的检查对其进行诊断和分期评估。113例患者中有7例在术中或组织病理学检查时发现为良性病变，因此被排除在随访和生存分析之外。在32例可能可切除的患者中，最终只有21例患者能够进行根治性切除。术中发现不可切除/转移性疾病的患者（n = 11），如果符合条件则接受姑息化疗。分析了手术切除患者的短期发病率、围手术期死亡率、无病生存期（DFS）和中位总生存期（OS）。将切除患者的中位OS与不可切除患者的进行比较。
本研究队列的总体可切除率为19.8%（21/106）。总体死亡率为4.7%，发病率为42.8%。切除患者的分期分布如下：II期（3例）、IIIA期（9例）、IIIB期（8例）和IVA期（1例）。发现12个月和18个月时的DFS分别为82.5%和73.3%。平均DFS为19.9个月（标准误1.42，95%置信区间）。切除患者的平均OS为21个月，不可切除患者的仅为11.3个月。两组使用对数秩（Mantel-cox）检验进行比较，观察到OS有统计学显著差异（p值<0.0001）。
由于根治性切除是唯一的治愈机会，我们采用的积极手术方法在可接受的死亡率和发病率情况下是合理的，并且总体生存期令人鼓舞。
