Kapoor V K, Haribhakti S P
Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow.
Trop Gastroenterol. 1995 Oct-Dec;16(4):74-5.
Resection was performed in 158 (70%) out of 227 patients with carcinoma of the gall bladder treated over 22 years between 1971 and 1993; 59 had simple cholecystectomy, 66 extended cholecystectomy (including 2 cm wedge resection of the liver at the gall bladder bed and regional lymphadenectomy in the hepatoduodenal ligament, behind the superior part of the pancreatic head and in the common hepatic artery region) and 33 had a more extended operation. Staging as proposed by the Japanese Society of Biliary Surgery (JSBS) was followed. Simple cholecystectomy was performed in 35 patients with stage I, 6 with stage II, 6 with stage III and 11 with stage IV disease while extended cholecystectomy was performed in 28 patients with stage I, 11 with stage II, 12 with stage III and 14 patients with stage IV disease. Survival was calculated using Kaplan - Meier method and log rank test was used for analysis of survival rates. The cumulative 5 year survival after extended cholecystectomy was 79% in stage I, 64% in stage II, 44% in stage III and 8% in stage IV. There was no difference in survival between stage I and II but survival in stage I was significantly better than that in stage III (p = 0.05). There was no statistically significant difference in survival after extended or simple cholecystectomy in stage I disease although incidence of recurrence was less after extended than after simple cholecystectomy (7% vs 17%). Extended cholecystectomy produced better survival than simple cholecystectomy in stage II disease (p = 0.04) but there was no difference between extended and simple cholecystectomy in stage III and IV disease. Retrospective analysis was performed to identify significant prognostic indicators. The significant factors for pior survival were N2, Hinf 1, Binf 1 and invasive cancer.
在1971年至1993年的22年间接受治疗的227例胆囊癌患者中,158例(70%)接受了手术切除;59例行单纯胆囊切除术,66例行扩大胆囊切除术(包括在胆囊床处楔形切除2 cm肝脏以及在肝十二指肠韧带、胰头上方后方和肝总动脉区域进行区域淋巴结清扫),33例行更广泛的手术。采用日本胆道外科学会(JSBS)提出的分期方法。35例I期、6例II期、6例III期和11例IV期疾病患者行单纯胆囊切除术,而28例I期、11例II期、12例III期和14例IV期疾病患者行扩大胆囊切除术。采用Kaplan-Meier法计算生存率,并使用对数秩检验分析生存率。扩大胆囊切除术后I期的累积5年生存率为79%,II期为64%,III期为44%,IV期为8%。I期和II期的生存率无差异,但I期的生存率明显优于III期(p = 0.05)。I期疾病行扩大或单纯胆囊切除术后的生存率无统计学显著差异,尽管扩大胆囊切除术后的复发率低于单纯胆囊切除术(7%对17%)。II期疾病中,扩大胆囊切除术的生存率优于单纯胆囊切除术(p = 0.04),但III期和IV期疾病中扩大和单纯胆囊切除术之间无差异。进行回顾性分析以确定显著的预后指标。术前生存的显著因素为N2、Hinf 1、Binf 1和浸润性癌。