Oncologic Outcomes of Extended Lymphadenectomy without Liver Resection for T1/T2 Gallbladder Cancer
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study provides a standardized operative strategical algorithm that can be applied to patients with T1/T2 gallbladdercancer (GBC). Our aim was to determine the oncologic outcome of radical cholecystectomy with para-aortic lymph node dissectionwithout liver resection in T1/T2 GBC. Materials and Methods: From January 2005 to December 2017, 164 patients with GBC underwent operations by a single surgeonat Severance Hospital. A retrospective review was performed for 113 of these patients, who were pathologically determined to be instages T1 and T2 according to American Joint Committee on Cancer 7th guidelines. Results: Of the 113 patients, 109 underwent curative resection for T1/T2 GBC; four patients who underwent palliative operationswithout radical cholecystectomies were excluded from further analyses. For all T1b and T2 lesions, radical cholecystectomy withpara-aortic lymph node dissection was performed without liver resection. There were four GBC-related mortalities, and 5-yeardisease-specific survival was 97.0%. The median follow-up was 50 months (range: 5–145 months). In all T stages, the median wasnot reached for survival analysis. Five-year disease-specific survival for T1a, T1b, and T2 were 100%, 94.1%, and 97.1%, respectively. Five-year disease-free survival for T1a, T1b, and T2 were 100%, 87.0%, and 91.8%, respectively. Conclusion: Our results suggest that the current operative protocol can be applied to minimal invasive operations for GBC withsimilar oncologic outcomes as open approach. For T1/T2 GBC, radical cholecystectomy, including para-aortic lymph node dissection,can be performed safely with favorable oncologic outcomes.
Abstract
Purpose: This study provides a standardized operative strategical algorithm that can be applied to patients with T1/T2 gallbladdercancer (GBC). Our aim was to determine the oncologic outcome of radical cholecystectomy with para-aortic lymph node dissectionwithout liver resection in T1/T2 GBC. Materials and Methods: From January 2005 to December 2017, 164 patients with GBC underwent operations by a single surgeonat Severance Hospital. A retrospective review was performed for 113 of these patients, who were pathologically determined to be instages T1 and T2 according to American Joint Committee on Cancer 7th guidelines. Results: Of the 113 patients, 109 underwent curative resection for T1/T2 GBC; four patients who underwent palliative operationswithout radical cholecystectomies were excluded from further analyses. For all T1b and T2 lesions, radical cholecystectomy withpara-aortic lymph node dissection was performed without liver resection. There were four GBC-related mortalities, and 5-yeardisease-specific survival was 97.0%. The median follow-up was 50 months (range: 5–145 months). In all T stages, the median wasnot reached for survival analysis. Five-year disease-specific survival for T1a, T1b, and T2 were 100%, 94.1%, and 97.1%, respectively. Five-year disease-free survival for T1a, T1b, and T2 were 100%, 87.0%, and 91.8%, respectively. Conclusion: Our results suggest that the current operative protocol can be applied to minimal invasive operations for GBC withsimilar oncologic outcomes as open approach. For T1/T2 GBC, radical cholecystectomy, including para-aortic lymph node dissection,can be performed safely with favorable oncologic outcomes.
참고문헌 (25)
- Hueman MT, "Evolving treatment strategies for gallbladder cancer", Ann Surg Oncol, 16, pp.2101~2115 (2009)
- Lazcano-Ponce EC, "Epidemiology and molecular pathology of gallbladder cancer", CA Cancer J Clin, 51, pp.349~364 (2001)
- 이승은, "Practical Guidelines for the Surgical Treatment of Gallbladder Cancer", Journal of Korean Medical Science, 29(10), pp.1333~1340 (2014), 대한의학회
- Randi G, "Gallbladder cancer worldwide : geographical distribution and risk factors", Int J Cancer, 118, pp.1591~1602 (2006)
- Lee SE, "Systematic review on the surgical treatment for T1 gallbladder cancer", World J Gastroenterol, 17, pp.174~180 (2011)
- Kim DH, "Role of cholecystectomy and lymph node dissection in patients with T2 gallbladder cancer", World J Surg, 37, pp.2635~2640 (2013)
- Hoehn RS, "Adjuvant therapy for gallbladder cancer : an analysis of the National Cancer Data Base", J Gastrointest Surg, 19, pp.1794~1801 (2015)
- Ma N, "Adjuvant therapy in the treatment of gallbladder cancer : a meta-analysis", BMC Cancer, 15, pp.615~ (2015)
- Dindo D, "Classification of surgical complications : a new proposal with evaluation in a cohort of 6336patients and results of a survey", Ann Surg, 240, pp.205~213 (2004)
- Blalock A, "A statistical study of eight hundred and eighty-eight cases of biliary tract disease", Johns Hopkins Hosp Bull, 35, pp.391~409 (1924)
- Itano O, "Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma", Surg Endosc, 29, pp.3600~3607 (2015)
- Lee H, "Surgical strategy for T2 gallbladder cancer according to tumor location", Ann Surg Oncol, 22, pp.2779~2786 (2015)
- Zimmitti G, "Current role of minimally invasive radical cholecystectomy for gallbladder cancer", Gastroenterol Res Pract (2016)
- Yoon YS, "Is laparoscopy contraindicated for gallbladder cancer? A 10-year prospective cohort study", J Am Coll Surg, 221, pp.847~853 (2015)
- Kang CM, "Does “clinical” R0 have validity in the choice of simple cholecystectomy for gallbladder carcinoma?", J Gastrointest Surg, 11, pp.1309~1316 (2007)
- Ito M, "Lymphatic drainage of the gallbladder", J Hepatobiliary Pancreat Surg, 1, pp.302~308 (1994)
- Tsukada K, "Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage", Surgery, 120, pp.816~821 (1996)
- Ogura Y, "Radical operations for carcinoma of the gallbladder : present status in Japan", World J Surg, 15, pp.337~343 (1991)
- Kondo S, "Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma", Br J Surg, 87, pp.418~422 (2000)
- Lee H, "Optimal extent of surgery for early gallbladder cancer with regard to long-term survival : a meta-analysis", J Hepatobiliary Pancreat Sci, 25, pp.131~141 (2018)
- Sternby Eilard M, "Surgical treatment for gallbladder cancer–a systematic literature review", Scand J Gastroenterol, 52, pp.505~514 (2017)
- Woohyun Jung, "Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer", Gut and Liver, 10(1), pp.140~146 (2016), 거트앤리버 소화기연관학회협의회
- Horiguchi A, "Gallbladder bed resection or hepatectomy of segments 4a and 5 for pT2 gallbladder carcinoma : analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery", J Hepatobiliary Pancreat Sci, 20, pp.518~524 (2013)
- Pitt SC, "Incidental gallbladder cancer at cholecystectomy : when should the surgeon be suspicious", Ann Surg, 260, pp.128~133 (2014)
- Eltawil KM, "Neuroendocrine tumors of the gallbladder : an evaluation and reassessment of management strategy", J Clin Gastroenterol, 44, pp.687~695 (2010)