Benoist S, Panis Y, Fagniez P L
Service de Chirurgie Digestive, Hôpital Henri-Mondor, Créteil, France.
Am J Surg. 1998 Feb;175(2):118-22. doi: 10.1016/s0002-9610(97)00269-9.
The surgical management of gallbladder carcinoma is controversial, especially as regards the indications for radical resection. The aim of this study was to evaluate the results of surgical treatment for gallbladder carcinoma with special reference to the extent of its histological spread.
Eighty-six patients from 25 French centers underwent resection for cure and were included in this study. They comprised 65 women and 21 men (mean age 65 +/- 21 years). Resection included radical resection in 21 patients (partial hepatectomy, regional lymphadenectomy, and common bile duct resection) and simple cholecystectomy in 65.
There were 3 postoperative deaths (3.5%). The mean follow-up period was 25 +/- 24 months. The overall 5-year actuarial survival rate was 26%. The 5-year actuarial survival rate was 27% for patients who had radical resection. Eight patients with nodal metastasis had a 5-year survival rate of 0%, but the rate for 13 patients without such metastasis was 43% (P <0.05). For patients undergoing simple cholecystectomy, the 5-year actuarial survival rate was 44% for stage I disease, 22% for stage II, and 0% for stage III (P <0.05).
In patients with stage I gallbladder carcinoma, outcome is good after cholecystectomy only. In stages II to IV, radical resection should only be considered in the absence of regional lymph node metastasis.
胆囊癌的手术治疗存在争议，尤其是在根治性切除的指征方面。本研究的目的是评估胆囊癌手术治疗的结果，并特别参考其组织学扩散范围。
来自法国25个中心的86例患者接受了根治性切除手术，并纳入本研究。其中包括65名女性和21名男性（平均年龄65±21岁）。切除手术包括21例患者的根治性切除（部分肝切除术、区域淋巴结清扫术和胆总管切除术）以及65例患者的单纯胆囊切除术。
术后有3例死亡（3.5%）。平均随访期为25±24个月。总体5年精算生存率为26%。接受根治性切除的患者5年精算生存率为27%。8例有淋巴结转移的患者5年生存率为0%，但13例无淋巴结转移的患者5年生存率为43%（P<0.05）。对于接受单纯胆囊切除术的患者，I期疾病的5年精算生存率为44%，II期为22%，III期为0%（P<0.05）。
对于I期胆囊癌患者，仅行胆囊切除术后预后良好。对于II至IV期患者，仅在无区域淋巴结转移的情况下才应考虑根治性切除。
