Cherkassky Leonid, D'Angelica Michael
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 USA.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 USA.
Surg Oncol Clin N Am. 2019 Oct;28(4):619-630. doi: 10.1016/j.soc.2019.06.005.
Managing patients with incidental gallbladder cancer requires stratifying patients risk for recurrence and an appreciation for the recurrence patterns characterizing this malignancy. Although standard management includes reresection to remove sites at risk of harboring residual disease and to achieve negative resection margin status, the decision to perform surgery is tempered by an early and frequent distant recurrence, the most common cause of surgical failure. High-risk patients may benefit from neoadjuvant chemotherapy before reresection. The goal of curative-intent reresection is achieving R0 margin status and optimal staging while limiting morbidity and mortality.
管理意外胆囊癌患者需要对患者的复发风险进行分层,并了解这种恶性肿瘤的复发模式。尽管标准治疗包括再次手术切除有残留疾病风险的部位并实现切缘阴性,但由于早期频繁远处复发这一手术失败的最常见原因,手术决策受到影响。高危患者可能从再次手术前的新辅助化疗中获益。根治性再次手术的目标是实现R0切缘状态和最佳分期,同时限制发病率和死亡率。