Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan.
Division of Molecular Pathology, National Cancer Centre Research Institute, Tokyo, Japan.
Br J Surg. 2018 Nov;105(12):1658-1664. doi: 10.1002/bjs.10913. Epub 2018 Jul 11.
Definitions of regional lymph nodes for gallbladder cancer differ according to staging system. Hence, the appropriate extent of lymph node dissection has not yet been standardized.
Pathological stages and disease-specific survival (DSS) of patients who had undergone surgical resection of gallbladder cancer between 1990 and 2016 were reviewed. Patients with nodal metastases limited to the hepatoduodenal ligament or common hepatic artery, extending to the posterosuperior pancreatic head lymph nodes (PSPLNs), or in nodes along the coeliac axis or superior mesenteric vessels were grouped as having Na, Nb and Nc disease respectively. Metastases beyond these regions were defined as distant metastases (M1). Absence of distant metastasis was expressed as M0.
A total of 259 patients were evaluated. There were 74, 31 and nine patients respectively in the Na, Nb and Nc groups. Twenty-five, nine and four patients in the respective groups had M1 disease (P = 0·682). The 5-year DSS rate was comparable between patients with Na M0 and those with Nb M0 disease (36 versus 34 per cent respectively; P = 0·950), whereas the rate in patients with Nc M0 status (0 per cent) was worse than that of patients with Nb M0 (P = 0·017) and comparable to that of patients with M1 disease (14 per cent; P = 0·590). Among 22 patients with Nb M0 disease, the 5-year DSS rate did not differ between those who had undergone pancreatoduodenectomy and those who had had dissection of PSPLNs without pancreatoduodenectomy (50 versus 30 per cent respectively; P = 0·499).
PSPLNs and nodes along the hepatoduodenal ligament and hepatic artery should be considered regional nodes for gallbladder cancer, and should be resected.
由于胆囊癌的分期系统不同，区域性淋巴结的定义也不同。因此，淋巴结清扫的适当范围尚未标准化。
回顾了 1990 年至 2016 年间接受胆囊癌手术切除的患者的病理分期和疾病特异性生存（DSS）。将局限于肝十二指肠韧带或肝总动脉、延伸至胰头后上区淋巴结（PSPLNs）或腹腔干或肠系膜上血管旁淋巴结的淋巴结转移患者分别分为 Na、Nb 和 Nc 疾病。超出这些区域的转移被定义为远处转移（M1）。无远处转移表示为 M0。
共评估了 259 例患者。Na、Nb 和 Nc 组分别有 74、31 和 9 例患者。在各自的组中，有 25、9 和 4 例患者分别患有 M1 疾病（P=0.682）。NaM0 患者与 NbM0 患者的 5 年 DSS 率相似（分别为 36%和 34%；P=0.950），而 NcM0 状态患者的 5 年 DSS 率（0%）差于 NbM0 患者（P=0.017），但与 M1 疾病患者（14%；P=0.590）相当。在 22 例 NbM0 疾病患者中，行胰十二指肠切除术与未行胰十二指肠切除术而行 PSPLN 清扫术的患者 5 年 DSS 率无差异（分别为 50%和 30%；P=0.499）。
PSPLNs 和肝十二指肠韧带及肝总动脉旁淋巴结应视为胆囊癌的区域淋巴结，应予以切除。
