Abstract
This retrospective study was designed to appraise the surgical procedures for pT2 gallbladder (GB) carcinomas. Twenty patients with pT2 GB carcinomas underwent surgical resection. Hepatectomy of segments 4b and 5 was performed in 19 patients, and an extended right hepatic lobectomy was performed in 1. The extrahepatic bile duct was preserved in 8 patients in whom the disease was limited to the GB fundus and/or body. Regional lymphadenectomy was performed in 18 patients. A separate radical second operation was performed in 8 patients after cholecystectomy. Final pathological staging was stage IB in 15 patients, IIB in 4, and IV in 1. Overall 5-year survival rate in those 20 patients was 77% without operative deaths. The 5-year survival rate in 5 patients with nodal metastasis and in 8 patients without extrahepatic biliary resection was 80% and 100%, respectively. A separate radical second operation in 8 patients yielded 75% survival after 5 years. Perineural invasion as a prognostic determinant was closely associated with tumor extending to the neck or the cystic duct. Partial hepatectomy, usually with extrahepatic biliary resection and regional lymphadenectomy, was appropriate as a standard radical operation for pT2 GB carcinoma, but preservation of extrahepatic bile duct is advocated for disease limited to the GB fundus and/or body. Radical second operation enhanced the chance for cure in patients with pT2 GB carcinoma.
Résumé
Cette étude rétrospective évalue les procédés chirurgicaux dans le traitement des cancers de la vésicule biliaire pT2. Vingt patients porteurs de tumeur de la vésicule biliaire pT2 ont eu une résection chirurgicale. L’hépatectomie des segments 4b et 5 a été réalisée chez 19 patients et une lobectomie droite étendue chez un. La voie biliaire extrahépatique a pu être préservée chez huit patients lorsque la maladie était limitée au fundus et/ ou au corps de la vésicule. Une lymphadénectomie régionale a été réalisée chez 18 patients. Une intervention radicale a été réalisée chez huit patients à distance de leur cholécystectomie initiale. Le staging anatomopathologique final a été stade « IB » chez 15 patients, stade « I1B » chez quatre, et stade « IV » chez un. Le taux de survie globale à 5 ans chez les 20 patients a été de 77%, sans aucune mortalité opératoire. Les taux de survie à 5 ans chez les cinq patients porteurs de métastases ganglionnaires et chez les huit patients sans résection extrahépatique, ont été, respectivement, de 80% et de 100%. En cas de deuxième intervention radicale, à distance, chez huit patients s’est soldée par une survie à 5 ans de 75%. L’envahissement périneural a été le facteur pronostique déterminant pour les tumeurs s’étendant au col vésiculaire et au canal cystique. L’hépatectomie partielle avec résection extrahépatique et une lymphadénectomie régionale ont été considérées comme l’intervention standard radicale en cas de tumeur pT2 mais la préservation de la voie biliaire extra-hépatique est conseillée en cas de cancer limité au fundus et/ou corps. L’intervention à distance radicale augmente les chances de cure chez le patient porteur de cancer pT2 de la vésicule biliaire.
Resumen
Se efectúa un estudio retrospectivo para averiguar el tratamiento quirúrgico realizado en carcinomas pT2 de vesícula biliar (GB). 20 pacientes con carcinomas pT2 de vesícula biliar (GB) fueron tratados quirúrgicamente. En 19 pacientes se efectuaron hepatectomías de los segmentos 4b y 5 y en 1 una lobectomía hepática derecha ampliada. La vía biliar extrahepática se conservó en 8 pacientes en los que la lesión estaba localizada, exclusivamente, en el fundus o cuerpo de la vesícula biliar. Iinfadenectomía regional se realizó en 18 casos. Fueron reintervenidos con criterios más radicales 8 pacientes tras sufrir una colecistectomía previa. La estadificación registrada fue la siguiente: estadio IB (n = 15) IIB (n = 4) y IV (n = 1 ). En los 20 pacientes la supervivencia global a los 5 años fue del 77%, sin mortalidad intraoperatoria alguna. La tasa de supervivencia a los 5 años en 5 pacientes con nódulos metastásicos y 8 sin resección biliar extrahepática fue del 80% y 100%. Una segunda operación más radical en 8 pacientes proportionó una tasa de supervivencia a los 5 años del 75%. Un factor pronóstico determinante fue la invasión perineural que se asociaba a la extensión del tumor hacia el cuello o al conducto cístico. La hepatectomía parcial generalmente acompañada de resección de la vía biliar extrahepática y linfadenectomía regional parece constituir la técnica quirúrgica estándar para los carcinomas pT2 de vesícula biliar, pero en los cánceres limitados al fundus y cuerpo de la vesícula se puede respetar la vía biliar extrahepática. Una segunda operación más radical, aumenta la posibilidad de curación en pacientes con carcinomas pT2 de vesícula biliar.
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Suzuki, S., Yokoi, Y., Kurachi, K. et al. Appraisal of surgical treatment for pT2 gallbladder carcinomas. World J. Surg. 28, 160–165 (2004). https://doi.org/10.1007/s00268-003-7080-y
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DOI: https://doi.org/10.1007/s00268-003-7080-y