Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.
Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.
Eur J Surg Oncol. 2022 Jul;48(7):1585-1589. doi: 10.1016/j.ejso.2022.03.013. Epub 2022 Mar 21.
Identification of early stage gallbladder cancer (GBC) is difficult with simple cholecystectomy being considered curative for T1a GBC but T1b requires radical cholecystectomy due to chances of lymph node metastasis. However there is no consensus regarding the optimal treatment strategy for T1b disease.
A retrospective review of a prospectively maintained database of GBC patients operated at our institute from March 2010 to March 2021 was conducted. Only patients with proven gallbladder adenocarcinoma on final histopathology report were included.
A total of 1245 patients of suspected GBC who underwent surgery during this period with 76 patients of T1b stage were analysed. We divided the group into a node positive cohort (n = 16, 9 received neoadjuvant treatment due to uptake in periportal nodes and 7 patients were pN1) and a node negative cohort (n = 60). The median nodal harvest was 8 nodes (2-24 nodes). Considering the radiological and pathological parameters, the rate of lymph node positivity was 21% (16/76). The overall major morbidity was 5.2% and there was no mortality. After a median follow up of 47.5 months, 3-year OS and DFS of the node negative and positive cohort was 96.7%, 91.7% and 75% and 62.5% (p = 0.058). The node positive cohort had 43% recurrences whereas the node negative cohort had 8.3% with all recurrences limited to periportal lymph nodes, distant nodes or liver metastasis.
Nodal positivity for T1b gall bladder cancer ranges around 21% and radical surgery with complete peri -portal lymphadenectomy should be considered as standard of care.
早期胆囊癌（GBC）的诊断较为困难，单纯行胆囊切除术被认为对 T1a GBC 具有根治性，但 T1b 由于存在淋巴结转移的可能性，需要行根治性胆囊切除术。然而，对于 T1b 疾病，尚无关于最佳治疗策略的共识。
对我院 2010 年 3 月至 2021 年 3 月期间行手术治疗的 GBC 患者的前瞻性数据库进行回顾性分析。仅纳入最终组织病理学报告证实为胆囊腺癌的患者。
在这段时间内，共有 1245 例疑似 GBC 患者接受了手术，其中 T1b 期患者 76 例。我们将该组分为阳性淋巴结组（n=16，9 例因门静脉周围淋巴结摄取而接受新辅助治疗，7 例为 pN1）和阴性淋巴结组（n=60）。淋巴结平均采集数为 8 个（2-24 个）。考虑到影像学和病理学参数，淋巴结阳性率为 21%（16/76）。总的主要发病率为 5.2%，无死亡率。中位随访 47.5 个月后，阴性和阳性淋巴结组的 3 年 OS 和 DFS 分别为 96.7%、91.7%和 75%和 62.5%（p=0.058）。阳性淋巴结组有 43%的患者复发，而阴性淋巴结组有 8.3%的患者复发，所有复发均局限于门静脉周围淋巴结、远处淋巴结或肝转移。
T1b 胆囊癌的淋巴结阳性率约为 21%，应考虑行根治性手术并进行完整的门静脉周围淋巴结清扫术作为标准治疗。
