Bloechle C, Izbicki J R, Passlick B, Gawad K, Passow C, Rogiers X, Schreiber H W, Broelsch C E
Department of Surgery, University Hospital Eppendorf, University of Hamburg, Germany.
Am J Gastroenterol. 1995 Dec;90(12):2195-200.
Advanced gallbladder carcinoma is associated with a dismal long term prognosis. The aim of the present study was to evaluate the effectiveness of radical surgery in advanced stages of gallbladder carcinoma.
The course of 66 patients operated for advanced gallbladder carcinoma was evaluated in a retrospective study; 14% of patients had stage II, 29% had stage III, and 57% had stage IV tumors. Twelve patients underwent cholecystectomy (CHE) and lymphadenectomy of the hepatoduodenal ligament (LA); 17 patients underwent cholecystectomy combined with segment IV/V liver resection (CHE+LR) and LA; and 10 patients underwent right extended hemihepatectomy (EHH). Complete tumor resection (R0) was achieved in six patients with CHE and LA, in 14 patients with CHE combined with segment IV/V LR and LA, and in all patients with right EHH. Resections with microscopic residual tumor (R1) were performed in nine patients. Mean follow-up was 15.4 months (range 3-90 months).
The perioperative mortality rate was 1.5%, and the morbidity rate was 20%. In R0 resections, mean survival was 23.3, 25.0, and 26.3 months for the patients who underwent CHE and LA, CHE combined with segment IV/V LR and LA, and right EHH, respectively. After 24 months, 46.4% of the patients with R0 resection were still alive compared with none of the patients with residual tumor. In the patients with R0 resection, no difference in survival was detected when node-negative status (pN0) was compared with positive locoregional lymph nodes (pN1a), whereas the degree of dedifferentiation (G2/G3) influenced survival.
If complete resection is achieved, radical surgical procedures, including segment IV/V liver resection and extended right hepatectomy, significantly improve survival rates with an acceptable morbidity and mortality rate.
晚期胆囊癌的长期预后不佳。本研究旨在评估根治性手术在晚期胆囊癌中的有效性。
在一项回顾性研究中评估了66例接受晚期胆囊癌手术患者的病程；14%的患者为II期，29%为III期，57%为IV期肿瘤。12例患者接受了胆囊切除术（CHE）和肝十二指肠韧带淋巴结清扫术（LA）；17例患者接受了胆囊切除术联合IV/V段肝切除术（CHE+LR）和LA；10例患者接受了右半肝扩大切除术（EHH）。6例接受CHE和LA的患者、14例接受CHE联合IV/V段LR和LA的患者以及所有接受右EHH的患者实现了肿瘤完全切除（R0）。9例患者进行了有镜下残留肿瘤的切除术（R1）。平均随访时间为15.4个月（范围3 - 90个月）。
围手术期死亡率为1.5%，发病率为20%。在R0切除术中，接受CHE和LA、CHE联合IV/V段LR和LA以及右EHH的患者的平均生存期分别为23.3个月、25.0个月和26.3个月。24个月后，R0切除患者中有46.4%仍存活，而有残留肿瘤的患者无一存活。在R0切除的患者中，当比较淋巴结阴性状态（pN0）与局部区域淋巴结阳性（pN1a）时，未检测到生存差异，而肿瘤去分化程度（G2/G3）影响生存。
如果实现完全切除，包括IV/V段肝切除术和右肝扩大切除术在内的根治性手术程序可显著提高生存率，且发病率和死亡率可接受。
