Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Kanai M, Uesaka K, Yuasa N, Sano T
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1998 Oct;99(10):728-32.
Seven reports of paraaortic lymphadenectomy for advanced carcinoma of the gallbladder were reviewed and positive paraaortic nodes were found in 20-40% of the resected patients and 10-15% of those with subserosal cancer invasion. The rate of patients with positive paraaortic nodes/all patients with positive nodes was 30-50%. Paraaortic lymphadenectomy did not improve the surgical outcome, and most of the patients with positive paraaortic nodes died within 1 year even after aggressive surgery with extensive lymph node dissection. Therefore it is important to clarify the value of paraaortic lymph node dissection for patients with possibly positive paraaortic node metastasis and those with histologically positive nodes excluding the paraaortic area. Although pancreatoduodenectomy for prophylactic lymphadenectomy around the head of the pancreas has been carried out in some institutions, the procedure does not seem to be effective because the main lymphatic route from the gallbladder has a direct connection with the paraaortic nodes via the pericholedochal, periportal, and/or the posterior nodes along the common hepatic artery. The present authors recommend a D2 plus paraaortic lymph node dissection (ext D2) as a standard surgical strategy for carcinoma of the gallbladder.
回顾了7篇关于晚期胆囊癌行腹主动脉旁淋巴结清扫术的报告，发现20%-40%的接受手术切除的患者腹主动脉旁淋巴结呈阳性，而浆膜下癌浸润患者中这一比例为10%-15%。腹主动脉旁淋巴结阳性患者占所有淋巴结阳性患者的比例为30%-50%。腹主动脉旁淋巴结清扫术并未改善手术结果，即使在进行了广泛淋巴结清扫的积极手术后，大多数腹主动脉旁淋巴结阳性的患者在1年内死亡。因此，明确腹主动脉旁淋巴结清扫术对于可能存在腹主动脉旁淋巴结转移的患者以及组织学检查腹主动脉旁区域以外淋巴结阳性的患者的价值非常重要。尽管一些机构已开展了胰十二指肠切除术以进行胰腺头部周围的预防性淋巴结清扫，但该手术似乎并不有效，因为胆囊的主要淋巴引流途径通过胆总管周围、门静脉周围和/或沿肝总动脉的后组淋巴结与腹主动脉旁淋巴结直接相连。本文作者推荐D2加腹主动脉旁淋巴结清扫术（扩大D2）作为胆囊癌的标准手术策略。
