Shirai Y, Tsukada K, Ohtani T, Watanabe H, Hatakeyama K
Department of Surgery, Niigata University Medical School, Japan.
Cancer. 1995 Apr 15;75(8):2063-8. doi: 10.1002/1097-0142(19950415)75:8<2063::aid-cncr2820750806>3.0.co;2-s.
The optimal hepatic resection margin for gallbladder cancer (GBC) is still debated. To explore this issue, the authors analyzed the mode of hepatic spread of GBC.
Of 85 patients undergoing radical cholecystectomy, 20 had hepatic metastases. The pattern of hepatic metastasis was examined grossly and histologically in specimens.
Twelve patients had evidence of microscopic angiolymphatic portal tract invasion, with or without direct liver invasion. Four had direct invasion alone, and three had distant hepatic metastatic nodules. The distance (y axis) between the farthest angiolymphatic lesion and primary tumor (mm) correlated significantly with the gross depth (x axis) of direct invasion (mm): y = 1.3 + 0.33x (r = 0.88, P < 0.01). Three patients with metastatic nodules died of blood-borne disease within a year. Eight of the others obtained either long-term palliation or cure after potentially curative resection. Lymph node metastases were detected in 90% of patients.
The extent of microscopic angiolymphatic portal tract invasion correlates well with the gross depth of direct invasion of the liver. This correlation may be useful for estimating adequate hepatectomy margins. A hepatectomy with an adequate margin combined with a radical lymphadenectomy provides benefit for selected patients with hepatic metastases.
胆囊癌（GBC）的最佳肝切除切缘仍存在争议。为探讨这一问题，作者分析了GBC的肝转移模式。
85例行根治性胆囊切除术的患者中，20例发生肝转移。对标本进行大体和组织学检查以确定肝转移模式。
12例患者有镜下血管淋巴管门静脉侵犯证据，伴或不伴肝脏直接侵犯。4例仅有直接侵犯，3例有远处肝转移结节。最远的血管淋巴管病变与原发肿瘤之间的距离（y轴，mm）与直接侵犯的大体深度（x轴，mm）显著相关：y = 1.3 + 0.33x（r = 0.88，P < 0.01）。3例有转移结节的患者在1年内死于血行播散性疾病。其他患者中有8例在进行了可能治愈性切除后获得了长期姑息或治愈。90%的患者检测到淋巴结转移。
镜下血管淋巴管门静脉侵犯程度与肝脏直接侵犯的大体深度密切相关。这种相关性可能有助于估计合适的肝切除切缘。具有足够切缘的肝切除联合根治性淋巴结清扫术对部分有肝转移的患者有益。
