Kamada Yasuyuki, Hori Tomohide, Yamamoto Hidekazu, Harada Hideki, Yamamoto Michihiro, Yamada Masahiro, Yazawa Takefumi, Tani Masaki, Sato Asahi, Tani Ryotaro, Aoyama Ryuhei, Sasaki Yudai, Zaima Masazumi
Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan.
World J Hepatol. 2020 Sep 27;12(9):641-660. doi: 10.4254/wjh.v12.i9.641.
Gallbladder cancer (GBC) is the most common biliary malignancy and has the worst prognosis, but aggressive surgeries [., resection of the extrahepatic bile duct (EHBD), major hepatectomy and lymph node (LN) dissection] may improve long-term survival. GBC may be suspected preoperatively, identified intraoperatively, or discovered incidentally on histopathology.
To present our data together with a discussion of the therapeutic strategies for GBC.
We retrospectively investigated nineteen GBC patients who underwent surgical treatment.
Nearly all symptomatic patients had poor outcomes, while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery. Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs. Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus. All patients with positive surgical margins (., the biliary cut surface) showed poor outcomes. Hepatectomies were performed in sixteen patients, nearly all of which were minor hepatectomies. Metastases were observed in the left-sided liver but not in the caudate lobe. We may need to reconsider the indications for major hepatectomy, minimizing its use except when it is required to accomplish negative bile duct margins. Only a few patients received neoadjuvant or adjuvant chemoradiation. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively.
Outcomes for GBC patients remain unacceptable, and improved therapeutic strategies, including neoadjuvant chemotherapy, optimal surgery and adjuvant chemotherapy, should be considered for patients with advanced GBCs.
胆囊癌（GBC）是最常见的胆道恶性肿瘤，预后最差，但积极的手术治疗（如肝外胆管切除、大范围肝切除和淋巴结清扫）可能改善长期生存率。胆囊癌可在术前被怀疑、术中被确诊或在组织病理学检查时偶然发现。
展示我们的数据，并讨论胆囊癌的治疗策略。
我们回顾性研究了19例接受手术治疗的胆囊癌患者。
几乎所有有症状的患者预后都很差，而早期可疑或偶然发现的胆囊癌患者预后良好，无需进行二期手术。在可疑/偶然发现的胆囊癌中，胆囊管周围的淋巴结是可靠的前哨淋巴结。对于早期胆囊癌，有意进行淋巴结清扫和肝外胆管切除可预防转移或复发，但对于有淋巴结转移或神经丛侵犯的晚期胆囊癌则无效。所有手术切缘阳性（如胆管切缘）的患者预后都很差。16例患者接受了肝切除术，几乎所有都是小范围肝切除。左侧肝脏发现转移，但尾状叶未发现转移。我们可能需要重新考虑大范围肝切除的适应证，尽量减少其使用，除非为了实现胆管切缘阴性而有必要进行。只有少数患者接受了新辅助或辅助放化疗。IIB期及以下和IIIA期及以上患者的总生存期和无病生存期存在显著差异。中位总生存期和无病生存期分别为1.66年和0.79年。
胆囊癌患者的预后仍然不容乐观，对于晚期胆囊癌患者，应考虑改进治疗策略，包括新辅助化疗、优化手术和辅助化疗。
