Clinicopathological Evaluation of Surgical Treatment for Early Gallbladder Cancer.
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概要
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We evaluated the therapeutic principles for early gallbladder cancer based on clinicopathological characteristics and outcomes in 27 patients encountered at the Kurume University Hospital between January, 1975 and December, 1999. Concerning the depth of wall penetration, 15 patients had mucosal cancers (m-cancers), and 12 patients muscularis propria cancers(mpcancers). The gross patterns were lp (pedunculated) in 16 patients, ls (sessile) in 3 patients, lla (flat elevated) in 4 patients, and llb (flat) in 4 patients. The operative procedure used was cholecystectomy (C) in 12 patients, 4 of whom underwent lymph node dissection. Full-thickness cholecystectomy (FTC) was carried out in 3 patients, one of whom had lymph node dissection. Combination of C and gallbladder bed resection (GbBR) was performed in 7 patients, 6 of whom had lymph node dissection. Combination of C and bile duct resection (BDR), and lymph node dissection was performed in 1 patient. Combination of C and GbBR and BDR, and lymph node dissection was performed in 6 patients. All the patients who underwent lymph node dissection were negative for metastasis. Of the 27 patients, 2 underwent laparoscopic operation: one with m-cancer was 79 years old, and the other with mp-cancer 86 years old. In the m-cancers, no lymphatic, venous or perineural infiltration was observed. In contrast, in the mp-cancers, lymphatic and venous infiltration each were observed in 4 patients (33.3%), although no perineural infiltration was observed. A diagnosis of gallbladder cancer was made postoperatively in 6 patients, of whom 4 hadthe llb pattern and all were complicated by gallstone, indicating the difficulty of diagnosing the llb pattern. The 5-year survival rates for the m-and mp-cancers were as high as 90.9% and 80.8%, respectively. As a curative surgical technique for m-and mp-cancers, lymph node dissection should be performed in addition to FTC, GbBR, and BDR, in combination. When a postoperative histopathologic diagnosis of gallbladder cancer has been made, no second-look operation should be performed for m-cancers, but lymph node dissection of up to the second group should be performed for mp-cancers in a second-look operation.
- 久留米大学医学部 The Kurume Medical Journal 編集部の論文
著者
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AOYAGI Shigeaki
Department of Cardiovascular Surgery, Kurume University School of Medicine
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HARA MASAO
Department of Mathematical Sciences, Tokai University
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IMAYAMA HIROYASU
Department of Surgery, Kurume University School of Medicine
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Nagashima Jun
Department Of Surgery Kurume University School Of Medicine
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Tamae Tsuyoshi
Department Of Surgery And Division Of Hepatic Surgery Kurume University School Of Medicine
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Hashino Kotaro
Department Of Surgery Kurume University School Of Medicine
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Kodama Takahito
Department Of Surgery Kurume University Medical Center
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Furukawa Satoshi
Department Of Aquatic Bioscience Graduate School Of Agricultural And Life Sciences The University Of
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Nishimura Kazunori
Department Of Cardiovascular Surgery Nagano Red Cross Hospital
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Kawabata Masahiro
Department Of Biochemistry The Cancer Institute Of Japanese Foundation For Cancer Research (jfcr) An
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Kinoshita Hisafumi
Department Of Surgery And Oncology Graduate School Of Medical Sciences Kyushu University
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Hashimoto Mitsuo
Department of Chemistry Faculty of Arts and Sciences Ibaraki University
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Hara Masao
Department of Industrial Chemistry, Faculty of Engineering, Yamaguchi University
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