Park Tae Jun, Ahn Keun Soo, Kim Yong Hoon, Kim Tae-Seok, Hong Jung Hee, Kang Koo Jeong
Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Department of Surgery, Andong Medical Group Hospital, Andong, Korea.
Ann Surg Treat Res. 2018 Mar;94(3):135-141. doi: 10.4174/astr.2018.94.3.135. Epub 2018 Feb 28.
The clinical behavior of T2 gallbladder cancer varies among patients. The aims of this study were to identify prognostic factors for survival and recurrence, and to determine the optimal surgical strategy for T2 gallbladder cancer.
We conducted a retrospective analysis of 78 patients with T2 gallbladder cancer who underwent surgical resection for gallbladder cancer.
Twenty-eight patients (35.9%) underwent simple cholecystectomy and 50 (64.1%) underwent extended cholecystectomy. Among 56 patients without LN metastasis (n = 20) or unknown LN status (no LN dissection, n = 36), the 5-year disease-free survival rates were 81.6%, and 69.8% (P = 0.080). In an analysis according to tumor location, patients with tumors located on the hepatic side (n = 36) had a higher recurrence rate than patients with tumors located on the peritoneal side only (n = 35) (P = 0.043). On multivariate analysis, R1 resection and lymph node metastasis were significant, independent prognostic factors for poor disease-free and overall survival.
R0 resection and LN dissection are an appropriate curative surgical strategy in patients with T2 gallbladder cancer. Tumors located on the hepatic side show worse prognosis than tumors located on the peritoneal side only, hepatic resection should be considered.
T2期胆囊癌患者的临床行为存在个体差异。本研究旨在确定生存和复发的预后因素，并确定T2期胆囊癌的最佳手术策略。
我们对78例行胆囊癌手术切除的T2期胆囊癌患者进行了回顾性分析。
28例（35.9%）患者行单纯胆囊切除术，50例（64.1%）患者行扩大胆囊切除术。在56例无淋巴结转移（n = 20）或淋巴结状态不明（未行淋巴结清扫，n = 36）的患者中，5年无病生存率分别为81.6%和69.8%（P = 0.080）。根据肿瘤位置分析，肿瘤位于肝侧的患者（n = 36）比仅位于腹膜侧的患者（n = 35）复发率更高（P = 0.043）。多因素分析显示，R1切除和淋巴结转移是无病生存和总生存不良的显著独立预后因素。
R0切除和淋巴结清扫是T2期胆囊癌患者合适的根治性手术策略。位于肝侧的肿瘤比仅位于腹膜侧的肿瘤预后更差，应考虑肝切除。
