Tsukada K, Hatakeyama K, Kurosaki I, Uchida K, Shirai Y, Muto T, Yoshida K
First Department of Surgery, Niigata University School of Medicine, Japan.
Surgery. 1996 Nov;120(5):816-21. doi: 10.1016/s0039-6060(96)80089-4.
The role of surgery in the treatment of gallbladder carcinoma (GBC) is controversial. The outcome after prospective radical surgery for GBC is discussed on the basis of the TNM stage of the tumor.
One hundred six patients who had undergone radical surgery were selected. The standard radical procedure consisted of a cholecystectomy accompanied by lymph node dissection, wedge resection of the liver, and resection of the extrahepatic bile ducts. The stage was determined by pathologic examination of resected specimens.
Lymph node metastases were identified in no patients with T1 tumors (n = 15), 48% of patients with T2 tumors (n = 46), 72% of patients with T3 tumors (n = 25), and 80% of patients with T4 tumors (n = 20). One patient died within 30 days after radical surgery (mortality rate, 0.9%). There were 35 5-year survivors including 11 patients with nodal involvement, 10 with stage I tumors, 13 with stage II tumors, 10 with stage III tumors, and 2 with stage IV tumors. The cumulative 5-year survival rate in patients with stage I tumors was 91% (n = 15), 85% in patients with stage II tumors (n = 24), 40% in patients with stage III tumors (n = 28), and 19% in patients with stage IV tumors (n = 39). In patients with stage III and IV tumors the 5-year survival rate was 52% after curative resection (n = 35). This was significantly better than the 5% 5-year survival rate after a noncurative resection (n = 32).
The presence of lymph node metastases is strongly influenced by the depth of invasion of the primary tumor. Accurate determination of the TNM stage is essential in comparing surgical results, predicting patient outcome, and planning additional treatment. Standard radical surgery contributes to patient survival and is recommended in patients with advanced GBC.
手术在胆囊癌（GBC）治疗中的作用存在争议。基于肿瘤的TNM分期探讨了GBC前瞻性根治性手术后的结果。
选取106例行根治性手术的患者。标准根治性手术包括胆囊切除术并伴有淋巴结清扫、肝楔形切除术和肝外胆管切除术。通过对切除标本进行病理检查确定分期。
T1期肿瘤患者（n = 15）均未发现淋巴结转移，T2期肿瘤患者（n = 46）中有48%发生淋巴结转移，T3期肿瘤患者（n = 25）中有72%发生淋巴结转移，T4期肿瘤患者（n = 20）中有80%发生淋巴结转移。1例患者在根治性手术后30天内死亡（死亡率为0.9%）。有35例5年生存者，包括11例有淋巴结受累患者、10例I期肿瘤患者、13例II期肿瘤患者、10例III期肿瘤患者和2例IV期肿瘤患者。I期肿瘤患者的5年累积生存率为91%（n = 15），II期肿瘤患者为85%（n = 24），III期肿瘤患者为40%（n = 28），IV期肿瘤患者为19%（n = 39）。III期和IV期肿瘤患者根治性切除后的5年生存率为52%（n = 35）。这明显优于非根治性切除后的5% 5年生存率（n = 32）。
淋巴结转移的存在受原发肿瘤浸润深度的强烈影响。准确确定TNM分期对于比较手术结果、预测患者预后以及规划后续治疗至关重要。标准根治性手术有助于患者生存，推荐用于晚期GBC患者。
