左半部分胆囊癌与右半部分胆囊癌的外科治疗
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摘要
目的探讨不同部位胆囊癌的预后以及外科手术对患者中位生存时间的影响。方法东方肝胆外科医院2012–2016年期间收治了382例胆囊癌患者,根据肿瘤的原发部位分为左半部分胆囊癌组(163例,包括了胆囊颈和胆囊管癌)和右半部分胆囊癌组(219例,包括了胆囊底部和体部癌)。全部患者均接受了手术治疗,其中包括标准根治术、扩大根治术以及姑息性切除术。结果 2组胆囊癌在肿瘤的侵犯深度、淋巴结转移、临床分期以及肿瘤分化程度方面比较差异均有统计学意义(P<0.05)。右半部分胆囊癌组患者的生存时间为(19.57±15.63)个月,左半部分胆囊组患者的生存时间为(14.62±11.12)个月,2组患者的生存时间比较差异有统计学意义(P<0.05);2组行根治手术后,左半部分胆囊癌组患者的生存时间为(23.82±12.47)个月,右半部分胆囊癌组患者的生存时间为(30.63±17.81)个月,2组比较差异无统计学意义(P>0.05);多因素分析结果表明,肿瘤部位、是否根治性手术、临床分期、病理学分级以及是否腺癌均是影响患者预后的独立危险因素(P<0.05)。2组接受扩大根治术与常规根治术患者的中位生存时间比较差异无统计学意义(P>0.05)。结论左半部分胆囊癌患者的预后较右半部分胆囊癌患者差,但接受根治性切除术后2组患者的预后相当;根据病情实施扩大根治术的预后也可与常规根治术的预后相近。两个部位胆囊癌在临床分期、病理分级和病理分类均有所区别,在手术方法尤其是扩大根治术的方法上有较大的区别,因此对这两个部位的胆囊癌在治疗上应当区别对待。
Objective To investigate the prognostic impact of tumor location in gallbladder carcinoma in different sites and evaluate the effect of surgical operation on the median survival time of patients. Methods From 2012 to 2016, 382 patients with gallbladder cancer in the Eastern Hepatobiliary Surgery Hospital were divided into 163 cases of gallbladder duct cancer and 219 cases of gallbladder bottom and body cancer. They were received radical resection,extended radical resection and palliative resection. Results The mean survival time was(19.57+15.63) months in the bottom and body cancer group,(14.62+11.12) months in the cystic duct carcinoma group, and the survival time was significantly different between the two groups(P<0.05). After radical surgery, the mean survival time in the cystic duct carcinoma group and the bottom and body cancer group were(23.82±12.47) months and(30.63±17.81) months,respectively, there was no significant difference between the two groups(P>0.05). The multivariate analysis indicated that tumor location, surgical radical therapy, clinical stage, pathological grade, and pathological classification were all independent risk factors influencing the prognosis of patients(P<0.05). There was no significant difference in median survival time between the two groups(P>0.05). Conclusions The prognosis of patients with cystic duct gallbladder carcinoma is worse than that of patients with the bottom and body cancer of the gallbladder, but the prognosis of the two groups after radical resection is similar. The prognosis of patients with extended radical operation according to the condition is similar to that of routine radical operation. There are some differences in clinical stage, pathological grade and pathological classification between the two groups of gallbladder cancer patients. In addition, the great differences exist in the surgical methods, especially in extended radical operation. Therefore, the treatment of gallbladder cancer in these two locations should be treated differently.
Objective To investigate the prognostic impact of tumor location in gallbladder carcinoma in different sites and evaluate the effect of surgical operation on the median survival time of patients. Methods From 2012 to 2016, 382 patients with gallbladder cancer in the Eastern Hepatobiliary Surgery Hospital were divided into 163 cases of gallbladder duct cancer and 219 cases of gallbladder bottom and body cancer. They were received radical resection,extended radical resection and palliative resection. Results The mean survival time was(19.57+15.63) months in the bottom and body cancer group,(14.62+11.12) months in the cystic duct carcinoma group, and the survival time was significantly different between the two groups(P<0.05). After radical surgery, the mean survival time in the cystic duct carcinoma group and the bottom and body cancer group were(23.82±12.47) months and(30.63±17.81) months,respectively, there was no significant difference between the two groups(P>0.05). The multivariate analysis indicated that tumor location, surgical radical therapy, clinical stage, pathological grade, and pathological classification were all independent risk factors influencing the prognosis of patients(P<0.05). There was no significant difference in median survival time between the two groups(P>0.05). Conclusions The prognosis of patients with cystic duct gallbladder carcinoma is worse than that of patients with the bottom and body cancer of the gallbladder, but the prognosis of the two groups after radical resection is similar. The prognosis of patients with extended radical operation according to the condition is similar to that of routine radical operation. There are some differences in clinical stage, pathological grade and pathological classification between the two groups of gallbladder cancer patients. In addition, the great differences exist in the surgical methods, especially in extended radical operation. Therefore, the treatment of gallbladder cancer in these two locations should be treated differently.
引文
1 Hueman MT, Vollmer CM, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol, 2009, 16(8):2101-2115.
2任培土,傅宏.不同部位原发性胆囊癌的诊治与预后.中国中西医结合外科杂志,2011,17(6):594-596.
3 Yamaguchi K, Chijiiwa K, Saiki S, et al. Retrospective analysis of70 operations for gallbladder carcinoma. Br J Surg, 1997, 84(2):200-204.
4 Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York:Springer. 2016.
5 Yokoyama Y, Nishio H, Ebata T, et al. New classification of cystic duct carcinoma. World J Surg, 2008, 32(4):621-626.
6 Sikora SS, Sinsh RK. Surgicat strategies in patients with gallbladder cancer:nihilism to optimism. J Surg Oncol, 2006, 93(8):670-681.
7 Farrar DA. Carcinoma of the cystic duct. Br J Surg, 1951, 39(154):183-185.
8段伟宏,周宁新,王知非.不同部位胆囊癌,扩大根治术的价值.外中华普通外科杂志,2011,9(26):739-742.
9 Pujani M1, Makker I, Makker A, et al. Expression of human epidermal growth factor receptor(Her 2/neu)and proliferative marker Ki-67:association with clinicopathological parameters in gallbladder carcinoma. Asian Pac J Cancer Prev, 2016, 17(8):3903-3909.
10 Wang L, Dong P, Zhang Y, et al. Prognostic validation of the updated 8th edition Tumor-Node-Metastasis classification by the Union for International Cancer Control:Survival analyses of 307patients with surgically treated gallbladder carcinoma. Oncol Lett,2018,16(4):4427-4433.
11 Nitta T, Kataoka J, Ohta M, et al. Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy. Ann Med Surg(Lond), 2018, 33(8):56-59.
12 Aldossary MY, Alayed AA, Amr S, et al. Primary squamous cell carcinoma of the gallbladder:Report of a rare neoplasm from the Eastern Province of Saudi Arabia. Int J Surg Case Rep, 2018, 51:186-189.
13冯飞灵,刘辰,谭蔚锋,等.胆囊癌侵犯胆管导致阻塞性黄疸手术治疗效果分析.第二军医大学学报,2010, 31(8):857-860.
14 Feng FL, Liu C, Li B, et al. Role of radical resection in patients with gallbladder carcinoma and jaundice. Chin Med J(Engl), 2012,125(5):752-756.
15 Hwang KY, Yoon YI, Hwang S, et al. Survival analysis following resection of AJCC stageⅢgallbladder carcinoma based on different combinations of T and N stages. Korean J Hepatobiliary Pancreat Surg, 2015, 19(1):11-16.
16 Utsumi M, Sadamori H, Shinoura S, et al. Risk factors of morbidity and predictors of long-term survival after hepatopancreatoduodenectomy for biliary cancer. Hepatogastroenterology, 2014,61(136):2167-2172.
17 Nanashima A, Nagasaki T, Sumida Y, et al. An experience of hepatopancreatoduodenectomy in patients with hepatobiliary malignancies. Hepatogastroenterology, 2008, 55(86-87):1691-1694.
18 Du J, Yang XW, Wen ZJ, et al. Relationship between prognosis and time interval from cholecystectomy to reoperation in postoperative incidental gallbladder carcinoma. Chin Med J(Engl),2018,131(20):2503-2505.
19 Sakuraoka Y, Suzuki T, Tanaka G, et al. A case of obstructive jaundice due to early carcinoma of the cystic duct protruding into the common bile duct. Int J Surg Case Rep, 2018, 52(10):28-34.
20 Bosch DE, Yeh MM, Schmidt RA, et al. Gallbladder carcinoma and epithelial dysplasia:Appropriate sampling for histopathology. Ann Diagn Pathol, 2018, 37(9):7-11.
2任培土,傅宏.不同部位原发性胆囊癌的诊治与预后.中国中西医结合外科杂志,2011,17(6):594-596.
3 Yamaguchi K, Chijiiwa K, Saiki S, et al. Retrospective analysis of70 operations for gallbladder carcinoma. Br J Surg, 1997, 84(2):200-204.
4 Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York:Springer. 2016.
5 Yokoyama Y, Nishio H, Ebata T, et al. New classification of cystic duct carcinoma. World J Surg, 2008, 32(4):621-626.
6 Sikora SS, Sinsh RK. Surgicat strategies in patients with gallbladder cancer:nihilism to optimism. J Surg Oncol, 2006, 93(8):670-681.
7 Farrar DA. Carcinoma of the cystic duct. Br J Surg, 1951, 39(154):183-185.
8段伟宏,周宁新,王知非.不同部位胆囊癌,扩大根治术的价值.外中华普通外科杂志,2011,9(26):739-742.
9 Pujani M1, Makker I, Makker A, et al. Expression of human epidermal growth factor receptor(Her 2/neu)and proliferative marker Ki-67:association with clinicopathological parameters in gallbladder carcinoma. Asian Pac J Cancer Prev, 2016, 17(8):3903-3909.
10 Wang L, Dong P, Zhang Y, et al. Prognostic validation of the updated 8th edition Tumor-Node-Metastasis classification by the Union for International Cancer Control:Survival analyses of 307patients with surgically treated gallbladder carcinoma. Oncol Lett,2018,16(4):4427-4433.
11 Nitta T, Kataoka J, Ohta M, et al. Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy. Ann Med Surg(Lond), 2018, 33(8):56-59.
12 Aldossary MY, Alayed AA, Amr S, et al. Primary squamous cell carcinoma of the gallbladder:Report of a rare neoplasm from the Eastern Province of Saudi Arabia. Int J Surg Case Rep, 2018, 51:186-189.
13冯飞灵,刘辰,谭蔚锋,等.胆囊癌侵犯胆管导致阻塞性黄疸手术治疗效果分析.第二军医大学学报,2010, 31(8):857-860.
14 Feng FL, Liu C, Li B, et al. Role of radical resection in patients with gallbladder carcinoma and jaundice. Chin Med J(Engl), 2012,125(5):752-756.
15 Hwang KY, Yoon YI, Hwang S, et al. Survival analysis following resection of AJCC stageⅢgallbladder carcinoma based on different combinations of T and N stages. Korean J Hepatobiliary Pancreat Surg, 2015, 19(1):11-16.
16 Utsumi M, Sadamori H, Shinoura S, et al. Risk factors of morbidity and predictors of long-term survival after hepatopancreatoduodenectomy for biliary cancer. Hepatogastroenterology, 2014,61(136):2167-2172.
17 Nanashima A, Nagasaki T, Sumida Y, et al. An experience of hepatopancreatoduodenectomy in patients with hepatobiliary malignancies. Hepatogastroenterology, 2008, 55(86-87):1691-1694.
18 Du J, Yang XW, Wen ZJ, et al. Relationship between prognosis and time interval from cholecystectomy to reoperation in postoperative incidental gallbladder carcinoma. Chin Med J(Engl),2018,131(20):2503-2505.
19 Sakuraoka Y, Suzuki T, Tanaka G, et al. A case of obstructive jaundice due to early carcinoma of the cystic duct protruding into the common bile duct. Int J Surg Case Rep, 2018, 52(10):28-34.
20 Bosch DE, Yeh MM, Schmidt RA, et al. Gallbladder carcinoma and epithelial dysplasia:Appropriate sampling for histopathology. Ann Diagn Pathol, 2018, 37(9):7-11.