Tewari M, Kumar S, Shukla S, Shukla H S
Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Cancer. 2016 Oct-Dec;53(4):552-557. doi: 10.4103/ijc.IJC_88_17.
Surgery (R0 resection) is the mainstay of treatment of gallbladder cancer (GBC) as GBC is relatively resistant to currently known chemotherapy and radiotherapy regimens.
to assess if wedge resection of the gallbladder bed achieves an adequate oncological clearance in GBC (namely T1 and T2) and some T3 GBC with minimal liver infiltration.
Patients with GBC who underwent radical cholecystectomy (en bloc cholecystectomy, wedge resection of the gallbladder fossa with a ≥2 cm rim of nonneoplastic liver tissue, and regional lymph node dissection) between October 2012 and June 2015 after obtaining informed consent.
Of thirty patients, mean age of 52 years, 5 had T1b, 13 T2, and 12 T3 GBC. R0 resection was achieved in all thirty GBC patients. Hepatic invasion was found in seven patients. The depth of hepatic invasion ranged from 0 to 9 mm. Follow-up ranged from a minimum of 12 to 43 months. Nineteen (63%) patients had N0 and 11 (37%) had N1 GBC. Total lymph node (TLND) count ranged from 1 to 12/patient with a median of 3. There was no local recurrence or systemic relapse of the disease.
Wedge resection of the gallbladder bed achieves an adequate oncological clearance in early GBC. TLND counts remain poor even after a thorough standard lymph node dissection for resectable GBC.
手术（R0切除）是胆囊癌（GBC）治疗的主要手段，因为GBC对目前已知的化疗和放疗方案相对耐药。
评估胆囊床楔形切除术在GBC（即T1和T2期）以及一些肝浸润最小的T3期GBC中是否能实现足够的肿瘤学切缘。
2012年10月至2015年6月期间，在获得知情同意后，对接受根治性胆囊切除术（整块胆囊切除术、胆囊窝楔形切除术，切缘为≥2 cm的非肿瘤性肝组织，并进行区域淋巴结清扫）的GBC患者进行研究。
30例患者，平均年龄52岁，其中5例为T1b期，13例为T2期，12例为T3期GBC。所有30例GBC患者均实现了R0切除。7例患者发现有肝侵犯。肝侵犯深度为0至9 mm。随访时间最短为12个月至43个月。19例（63%）患者为N0期，11例（37%）患者为N1期GBC。每位患者的总淋巴结（TLND）计数为1至12个，中位数为3个。未出现疾病的局部复发或全身复发。
胆囊床楔形切除术在早期GBC中能实现足够的肿瘤学切缘。即使对可切除的GBC进行了彻底的标准淋巴结清扫，TLND计数仍然不理想。
