Gani Faiz, Buettner Stefan, Margonis Georgios A, Ethun Cecilia G, Poultsides George, Tran Thuy, Idrees Kamran, Isom Chelsea A, Fields Ryan C, Krasnick Bradley, Weber Sharon M, Salem Ahmed, Martin Robert C G, Scoggins Charles, Shen Perry, Mogal Harveshp D, Schmidt Carl, Beal Eliza, Hatzaras Ioannis, Shenoy Rivfka, Maithel Shishir K, Pawlik Timothy M
Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
J Surg Oncol. 2016 Aug;114(2):176-80. doi: 10.1002/jso.24283. Epub 2016 May 20.
Although radical re-resection for gallbladder cancer (GBC) has been advocated, the optimal extent of re-resection remains unknown. The current study aimed to assess the impact of common bile duct (CBD) resection on survival among patients undergoing surgery for GBC.
Patients undergoing curative-intent surgery for GBC were identified using a multi-institutional cohort of patients. Multivariable Cox-proportional hazards regression was performed to identify risk factors for a poor overall survival (OS).
Among the 449 patients identified, 26.9% underwent a concomitant CBD resection. The median number of lymph nodes harvested did not differ based on CBD resection (CBD, 4 [IQR: 2-9] vs. no CBD, 3 [IQR: 1-7], P = 0.108). While patients who underwent a CBD resection had a worse OS, after adjusting for potential confounders, CBD resection did not impact OS (HR = 1.40, 95%CI 0.87-2.27, P = 0.170). Rather, the presence of advanced disease (T3: HR = 3.11, 95%CI 1.22-7.96, P = 0.018; T4: HR = 7.24, 95%CI 1.70-30.85, P = 0.007) and the presence of disease at the surgical margin (HR = 2.58, 95%CI 1.26-5.31, P = 0.010) were predictive of a worse OS.
CBD resection did not yield a higher lymph node count and was not associated with an improved survival. Routine CBD excision in the re-resection of GBC is unwarranted and should only be performed selectively. J. Surg. Oncol. 2016;114:176-180. © 2016 Wiley Periodicals, Inc.
尽管有人主张对胆囊癌（GBC）进行根治性再次手术切除，但最佳的再次切除范围仍不明确。本研究旨在评估胆总管（CBD）切除对接受GBC手术患者生存的影响。
利用多机构患者队列确定接受GBC根治性手术的患者。进行多变量Cox比例风险回归以确定总生存期（OS）较差的危险因素。
在确定的449例患者中，26.9%接受了同期CBD切除。根据CBD切除情况，所采集淋巴结的中位数无差异（CBD组，4个[四分位间距：2 - 9个] vs. 未行CBD切除组，3个[四分位间距：1 - 7个]，P = 0.108）。虽然接受CBD切除的患者OS较差，但在调整潜在混杂因素后，CBD切除并未影响OS（风险比[HR] = 1.40，95%置信区间[CI] 0.87 - 2.27，P = 0.170）。相反，存在进展期疾病（T3期：HR = 3.11，95%CI 1.22 - 7.96，P = 0.018；T4期：HR = 7.24，95%CI 1.70 - 30.85，P = 0.007）以及手术切缘存在病变（HR = 2.58，95%CI 1.26 - 5.31，P = 0.010）可预测OS较差。
CBD切除并未使淋巴结数量增加，且与生存率提高无关。GBC再次切除时常规进行CBD切除是不必要的，应仅选择性地进行。《外科肿瘤学杂志》2016年；114:176 - 180。© 2016威利期刊公司
