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首页> 外文期刊>Annals of surgical oncology >Gallbladder cancer: Defining the indications for primary radical resection and radical re-resection.
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Gallbladder cancer: Defining the indications for primary radical resection and radical re-resection.

机译：胆囊癌：定义主要根治性切除和根治性切除的适应症。

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BACKGROUND: The role of radical resection for gallbladder cancer is an ongoing area of debate. In this review, we present our experience managing gallbladder cancer at a tertiary center by using an aggressive surgical approach for T2 or greater disease, reserving simple cholecystectomy only for T1 lesions. METHODS: Seventy-six patients with histologically confirmed gallbladder cancer were identified from our cancer registry. Estimated survival distributions were calculated by the Kaplan-Meier method, and comparisons were made by using the log-rank test. The Cox proportional hazards model was used to determine the effect on survival of T stage, nodal status, age, and margins. RESULTS: Sixty-four patients were assessable for this study. Simple cholecystectomy was the only procedure performed in 10 T2 and 15 T3 cases. Radical cholecystectomy was performed as the primary procedure in two T2, two T3, and six T4 cases. Radical re-resection was accomplished in seven T2 and two T3 cases. Excluding the T4 group, there was a significant survival advantage (P = .007) for the radical resection group (n = 13; median survival not yet reached) compared with the simple cholecystectomy group (n = 25; median survival, 17 months; 95% confidence interval, 7-27 months). Analysis of the 13 T2 and T3 patients who underwent radical resections revealed that the radical re-resection group (n = 9) had an overall survival similar to that of the primarily resected group (n = 4). All T2N(+) and T3N(-) patients are still alive and disease free after 5 years of follow-up, whereas none of the T3N(+) or T4 patients survived beyond 24 months. Increasing T stage and age (>65 years) were independent predictors of a poor prognosis. CONCLUSIONS: Radical resection for T2 and T3 disease resulted in a significant survival advantage compared with simple cholecystectomy. Patients who undergo radical re-resection after an incidentally discovered gallbladder cancer experience the same survival benefit as primarily resected patients. Radical resection for T2N(-), T2N(+), and T3N0 cases can achieve long-term survival. Conversely, the prognosis for T3N(+) and T4 patients is poor, and improved outcome for this group will likely depend on the development of multi-institutional neoadjuvant clinical trials that can identify effective systemic regimens.
机译：背景：根治性切除术在胆囊癌中的作用一直是争论的焦点。在本综述中，我们介绍了通过在T2或更严重的疾病中采用积极的手术方法，仅对T1病变保留简单的胆囊切除术而在三级中心管理胆囊癌的经验。方法：从我们的癌症登记处中识别出76例经组织学证实为胆囊癌的患者。估计的生存分布通过Kaplan-Meier方法计算，并通过对数秩检验进行比较。使用Cox比例风险模型确定对T期存活，淋巴结状态，年龄和边缘的影响。结果：64名患者是可评估的这项研究。在10例T2和15例T3病例中，仅进行简单的胆囊切除术。在2例T2、2例T3和6例T4病例中，以根治性胆囊切除术为主要手术方法。根治性切除术在7例T2和2例T3病例中完成。与简单的胆囊切除术组（n = 25;中位生存期17个月; n = 13;中位生存期17个月）相比，不包括T4组的根治性切除术组（n = 13;中位生存期尚未达到）具有显着的生存优势（P = .007）。 95％置信区间（7-27个月）。对13例行根治性切除术的T2和T3患者的分析显示，根治性切除术组（n = 9）的总体生存率与初次切除组（n = 4）相似。随访5年后，所有T2N（+）和T3N（-）患者仍然活着并且没有疾病，而T3N（+）或T4患者均没有存活超过24个月。 T期和年龄的增加（> 65岁）是预后不良的独立预测因素。结论：与单纯胆囊切除术相比，根治性切除T2和T3疾病具有明显的生存优势。偶然发现胆囊癌后进行根治性切除的患者与最初切除的患者具有相同的生存获益。 T2N（-），T2N（+）和T3N0病例的根治性切除术可实现长期生存。相反，T3N（+）和T4患者的预后较差，该组患者预后的改善可能取决于能够确定有效全身方案的多机构新辅助临床试验的开展。

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