Izumi T, Shimada H, Maehara M, Katayama K, Note M, Seki H, Nakagawara G
First Department of Surgery, Fukui Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1993 Jul;94(7):722-9.
The mode of spread and the prognosis were investigated in 22 patients with resected gallbladder carcinoma invading the subserosal layer. By the Kaplan-Meier method, the 5-year survival rate was 68.8% in patients receiving curative or relatively noncurative resection. On the other hand, no patient survived for more than 3 years after noncurative resection. The mode of subserosal infiltration was classified according to the general rules for gastric cancer study. At least systemic lymph node dissection (R2) should be performed in patients with ss alpha cancer, because lymph node metastasis in these patients were confined to the 1st group. More extensive lymph node dissection (R2 with 9, 16) is essential for patients with ss beta and ss gamma, because lymph node metastasis to at least the 2nd group were seen in 75% of them. The surgical margin was positive for cancer in all patient with infiltration of the hepatoduodenal ligament. Therefore, it was considered that hepatoligamentectomy should be performed in these patients to obtain a cancer free surgical margin. Among patients undergoing curative or relatively noncurative resection, the recurrence rate was 43% in those with lymph node metastasis and 50% in those with DNA aneuploidy. Therefore, it appears that adjuvant chemotherapy should be given to such patients.
对22例已切除的侵犯浆膜下层的胆囊癌患者的扩散方式和预后进行了研究。采用Kaplan-Meier法，接受根治性或相对非根治性切除的患者5年生存率为68.8%。另一方面，非根治性切除后没有患者存活超过3年。浆膜下浸润方式根据胃癌研究的一般规则进行分类。对于ssα期癌症患者，至少应进行系统性淋巴结清扫（R2），因为这些患者的淋巴结转移局限于第1组。对于ssβ期和ssγ期患者，更广泛的淋巴结清扫（R2加第9、16组）至关重要，因为其中75%的患者至少出现了第2组淋巴结转移。所有肝十二指肠韧带浸润患者的手术切缘均有癌阳性。因此，认为这些患者应进行肝韧带切除术以获得无癌手术切缘。在接受根治性或相对非根治性切除的患者中，有淋巴结转移的患者复发率为43%，有DNA非整倍体的患者复发率为50%。因此，似乎应该对这些患者进行辅助化疗。
