Tashiro S
First Department of Surgery, University of Tokushima School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1998 Oct;99(10):706-10.
The postoperative survival rate is dependent on the invasive depth of cancer of the gallbladder, as shown in in our studies and in other Japanese studies detailed in questionnaires. In cases of m, mp cancer, good survival rates are achieved after simple cholecystectomy or wedge resection of the liver including the gallbladder bed with regional lymphadenectomy. However, when the cancer has invaded beyond the subserosal layer, lymph node and adjacent organ involvement is found in a large number of patients, and long-term survival cannot be achieved by wedge resection of the liver with dissection of the cystic nodes and pericholedochal lymph nodes. The poor prognosis of patients with these lesions might be due to the use of inappropriate surgical procedures. When the appropriate procedures based on the extent of subserosal (ss) invasiveness of gallbladder cancer were used, long-term survival was obtained in our patient series. The appropriate radical surgical procedures for ss cancer are as follows: When cancer is diagnosed as invading to the ss layer by intraoperative ultrasonography (IOUS), wedge resection of the liver including the gallbladder bed and D2 dissection of the lymph nodes including the paraaortic lymph nodes (16a2 inter, 16b1 inter pre) should be performed. When liver involvement (Hinf1-Hinf2) is diagnosed by IOUS or cancer is located on the liver bed, resection of segment 4a 5 in Couinaud's classification is performed. When there is involvement of the pericholedochal nodes, nodes around the common hepatic artery, and/or posterior pancreatoduodenal nodes are found at operation, pancreatoduodenectomy should be performed. Wedge resection of the liver or S4a 5 segmental resection of the liver with resection of the bile duct and D2 dissection of the lymph nodes including the paraaortic lymph nodes is considered to be the standard radical operation for many patients with ss cancer of the gallbladder.
术后生存率取决于胆囊癌的浸润深度，正如我们的研究以及问卷调查中详述的其他日本研究所示。对于m、mp期癌症患者，单纯胆囊切除术或包括胆囊床的肝楔形切除术加区域淋巴结清扫术后可获得良好的生存率。然而，当癌症侵犯至浆膜下层以外时，大量患者会出现淋巴结及邻近器官受累，通过切除胆囊周围淋巴结及肝门周围淋巴结的肝楔形切除术无法实现长期生存。这些患者预后较差可能是由于手术方式不当。当采用基于胆囊癌浆膜下（ss）浸润范围的合适手术方式时，我们的患者系列获得了长期生存。ss期癌症的合适根治性手术方式如下：术中超声（IOUS）诊断癌症侵犯至ss层时，应行包括胆囊床的肝楔形切除术及包括主动脉旁淋巴结（16a2组、16b1组）的D2淋巴结清扫术。IOUS诊断有肝脏受累（Hinf1-Hinf2）或癌症位于肝床时，应行Couinaud分类法中的4a、5段切除术。术中发现肝门周围淋巴结、肝总动脉周围淋巴结和/或胰十二指肠后淋巴结受累时，应行胰十二指肠切除术。对于许多胆囊ss期癌症患者，肝楔形切除术或肝S4a、5段切除术加胆管切除及包括主动脉旁淋巴结的D2淋巴结清扫术被认为是标准的根治性手术。
