潜在性胆嚢癌における外科的治療と長期予後の検討
本検討では胆嚢摘出術にて偶発的に発見される潜在性胆嚢癌の臨床病理学的特徴，外科治療，術後予後を明らかにすることを目的とし，根治的手術を施行した潜在性胆嚢癌11症例，非潜在性胆嚢癌26症例について後ろ向き観察研究を行った．潜在性胆嚢癌は胆嚢頚部に存在し肉眼的形態では平坦浸潤型を示すことが有意に多かった．潜在性胆嚢癌では胆管合併切除を行った症例が非潜在性胆嚢癌と比較し有意に多く，胆管合併切除を行った潜在性胆嚢癌全4症例は頸部に存在する平坦浸潤型であり胆嚢管への癌浸潤を認めた．5年無再発生存率は潜在性胆嚢癌群81.8%，非潜在性胆嚢癌群45.8%であった（p=0.045）．また，胆管合併切除を行った...
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| Published in | Tando Vol. 32; no. 5; pp. 842 - 848 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本胆道学会
31.12.2018
Japan Biliary Association |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-0077 1883-6879 |
| DOI | 10.11210/tando.32.842 |
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| Abstract | 本検討では胆嚢摘出術にて偶発的に発見される潜在性胆嚢癌の臨床病理学的特徴，外科治療，術後予後を明らかにすることを目的とし，根治的手術を施行した潜在性胆嚢癌11症例，非潜在性胆嚢癌26症例について後ろ向き観察研究を行った．潜在性胆嚢癌は胆嚢頚部に存在し肉眼的形態では平坦浸潤型を示すことが有意に多かった．潜在性胆嚢癌では胆管合併切除を行った症例が非潜在性胆嚢癌と比較し有意に多く，胆管合併切除を行った潜在性胆嚢癌全4症例は頸部に存在する平坦浸潤型であり胆嚢管への癌浸潤を認めた．5年無再発生存率は潜在性胆嚢癌群81.8%，非潜在性胆嚢癌群45.8%であった（p=0.045）．また，胆管合併切除を行った潜在性胆嚢癌症例では術後再発を認めなかった．潜在性胆嚢癌は平坦浸潤型が胆嚢頚部に存在することが多く，根治的切除を行う際には胆嚢管への浸潤を注意深く評価し，胆管合併切除を考慮する必要があると考えられた． |
|---|---|
| AbstractList | 本検討では胆嚢摘出術にて偶発的に発見される潜在性胆嚢癌の臨床病理学的特徴，外科治療，術後予後を明らかにすることを目的とし，根治的手術を施行した潜在性胆嚢癌11症例，非潜在性胆嚢癌26症例について後ろ向き観察研究を行った．潜在性胆嚢癌は胆嚢頚部に存在し肉眼的形態では平坦浸潤型を示すことが有意に多かった．潜在性胆嚢癌では胆管合併切除を行った症例が非潜在性胆嚢癌と比較し有意に多く，胆管合併切除を行った潜在性胆嚢癌全4症例は頸部に存在する平坦浸潤型であり胆嚢管への癌浸潤を認めた．5年無再発生存率は潜在性胆嚢癌群81.8%，非潜在性胆嚢癌群45.8%であった（p=0.045）．また，胆管合併切除を行った潜在性胆嚢癌症例では術後再発を認めなかった．潜在性胆嚢癌は平坦浸潤型が胆嚢頚部に存在することが多く，根治的切除を行う際には胆嚢管への浸潤を注意深く評価し，胆管合併切除を考慮する必要があると考えられた． The aim is in this study to evaluate the clinicopathological characteristics, surgical procedures, and the long-term outcome of patients with incidental gallbladder carcinoma (IGBC). We performed a retrospective cohort study of 11 IGBC and 26 non-IGBC (NIGBC) patients who underwent curative resection from 2004 to 2014. Most IGBC was located at the neck of the gallbladder and was a flat invasive tumor type. The proportion of IGBC patients who underwent bile duct resection was significantly higher than that of NIGBC patients. All 4 IGBC patients with flat invasive type tumors located at the neck received bile duct resection due to involvement of the cystic duct. The 5-year recurrence-free survival rates of patients in the NIGBC and IGBC groups were 45.8 and 81.8%, respectively (p=0.045). Most importantly, the IGBC patients receiving radical cholecystectomy with bile duct resection had a good prognosis. Because IGBC was more likely to be flat invasive type located at the neck of the gallbladder, surgeons should perform the best surgical management, including bile duct resection, considering the possibility of involvement of the cystic duct margins. 本検討では胆嚢摘出術にて偶発的に発見される潜在性胆嚢癌の臨床病理学的特徴，外科治療，術後予後を明らかにすることを目的とし，根治的手術を施行した潜在性胆嚢癌11症例，非潜在性胆嚢癌26症例について後ろ向き観察研究を行った．潜在性胆嚢癌は胆嚢頚部に存在し肉眼的形態では平坦浸潤型を示すことが有意に多かった．潜在性胆嚢癌では胆管合併切除を行った症例が非潜在性胆嚢癌と比較し有意に多く，胆管合併切除を行った潜在性胆嚢癌全4症例は頸部に存在する平坦浸潤型であり胆嚢管への癌浸潤を認めた．5年無再発生存率は潜在性胆嚢癌群81.8%，非潜在性胆嚢癌群45.8%であった（p=0.045）．また，胆管合併切除を行った潜在性胆嚢癌症例では術後再発を認めなかった．潜在性胆嚢癌は平坦浸潤型が胆嚢頚部に存在することが多く，根治的切除を行う際には胆嚢管への浸潤を注意深く評価し，胆管合併切除を考慮する必要があると考えられた． 「要旨」: 本検討では胆嚢摘出術にて偶発的に発見される潜在性胆嚢癌の臨床病理学的特徴, 外科治療, 術後予後を明らかにすることを目的とし, 根治的手術を施行した潜在性胆嚢癌11症例, 非潜在性胆嚢癌26症例について後ろ向き観察研究を行った. 潜在性胆嚢癌は胆嚢頚部に存在し肉眼的形態では平坦浸潤型を示すことが有意に多かった. 潜在性胆嚢癌では胆管合併切除を行った症例が非潜在性胆嚢癌と比較し有意に多く, 胆管合併切除を行った潜在性胆嚢癌全4症例は頸部に存在する平坦浸潤型であり胆嚢管への癌浸潤を認めた. 5年無再発生存率は潜在性胆嚢癌群81.8%, 非潜在性胆嚢癌群45.8%であった(p=0.045). また, 胆管合併切除を行った潜在性胆嚢癌症例では術後再発を認めなかった. 潜在性胆嚢癌は平坦浸潤型が胆嚢頚部に存在することが多く, 根治的切除を行う際には胆嚢管への浸潤を注意深く評価し, 胆管合併切除を考慮する必要があると考えられた. |
| Author | 田浦, 康二朗 中村, 直彦 上本, 伸二 井口, 公太 瀬尾, 智 波多野, 悦朗 |
| Author_FL | Hatano Etsuro 井口 公太 Uemoto Shinji 中村 直彦 Seo Satoru Taura Kojiro |
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| Copyright | 2018 日本胆道学会 |
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| References | 9) Shih SP, Schulick RD, Cameron JL, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2007; 245: 893-901 7) Zhang WJ, Xu GF, Zou XP, et al. Incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy. Would J Surg 2009; 33: 2651-2656 16) Cavallaro A, Piccolo G, Di Vita M, et al. Managing the incidentally detected gallbladder cancer: Algorithms. Int J Sur 2014; 12: 108-119 19) Foster JM, Hoshi H, Gibbs JF. Gallbladder cancer: defining the indications for primary radical resection and radical reresection. Ann Surg Oncol 2007; 14: 833-840 21) Tian YH, Ji X, Liu B, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. Would J Surg 2015; 39: 746-752 6) Isambert M, Leux C, Metairie S. Incidentally-discovered gallbladder cancer: when, why and which reoperation? J Visc Surg 2011; 148: e77-84 20) Choi KS, Choi SB, Park P, et al. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis. World J Gastroenterol 2015; 21: 1315-1323 2) Fuks D, Regimbeau JM, Le YP Treut, et al. Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg 2011; 35: 1887-1897 8) Choi SB, Han HJ, Kim CY, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 2009; 33: 2657-2663 18) Singh S, Agarwal AK. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2009; 250: 494-495 3) Duffy A, Capanu M, Abou-Alfa GK, et al. Gallbladder cancer (GBC): 10-year experience at memorial Sloan-Kettering Cancer Center (MSKCC). J Surg Oncol 2008; 98: 485-489 4) Jensen EH, Abraham A, Habermann EB, et al. A critical analysis of the surgical management of early stage gallbladder cancer in the United States. J Gastrointest Surg 2009; 13: 722-727 17) Yi X, Long X, Zai H, et al. Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: focus on appropriate radical re-resection according to the T-stage. Clin Transl Oncol 2013; 15: 652-658 15) Giuliante F, Ardito F, Vellone M. Port-sites excision for gallbladder cancer incidentally found after laparoscopic cholecystectomy. Am J Surg 2006; 191: 114-116 1) Misra S, Chaturvedi A, Misra NC, et al. Carcinoma of the gall bladder. Lancet Oncol 2003; 2: 167-176 11) Barreto SG, Pawar S, Shah S. Patterns of failure and determinants of outcomes following radical re-resection for incidental gallbladder cancer. World J Surg 2014; 38: 484-489 5) Kapoor VK. Incidental gallbladder cancer. Am J Gastroenterol 2001; 96: 627-629 13) Edge SB, Carolyn CC. The American Joint Committee on Cancer: the 7th Edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471-1474 10) Ito H, Ito K, D'Angelica M. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg 2011; 254: 320-325 12) Goetze T, Paolucci V. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc 2006; 20: 286-293 14) Miyazaki M, Ohtsuka M, Miyakawa S, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3 (rd) English edition. J Hepatobiliary Pancreat Sci 2015; 22: 181-196 |
| References_xml | – reference: 4) Jensen EH, Abraham A, Habermann EB, et al. A critical analysis of the surgical management of early stage gallbladder cancer in the United States. J Gastrointest Surg 2009; 13: 722-727 – reference: 19) Foster JM, Hoshi H, Gibbs JF. Gallbladder cancer: defining the indications for primary radical resection and radical reresection. Ann Surg Oncol 2007; 14: 833-840 – reference: 1) Misra S, Chaturvedi A, Misra NC, et al. Carcinoma of the gall bladder. Lancet Oncol 2003; 2: 167-176 – reference: 14) Miyazaki M, Ohtsuka M, Miyakawa S, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3 (rd) English edition. J Hepatobiliary Pancreat Sci 2015; 22: 181-196 – reference: 17) Yi X, Long X, Zai H, et al. Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: focus on appropriate radical re-resection according to the T-stage. Clin Transl Oncol 2013; 15: 652-658 – reference: 18) Singh S, Agarwal AK. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2009; 250: 494-495 – reference: 13) Edge SB, Carolyn CC. The American Joint Committee on Cancer: the 7th Edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471-1474 – reference: 16) Cavallaro A, Piccolo G, Di Vita M, et al. Managing the incidentally detected gallbladder cancer: Algorithms. Int J Sur 2014; 12: 108-119 – reference: 3) Duffy A, Capanu M, Abou-Alfa GK, et al. Gallbladder cancer (GBC): 10-year experience at memorial Sloan-Kettering Cancer Center (MSKCC). J Surg Oncol 2008; 98: 485-489 – reference: 5) Kapoor VK. Incidental gallbladder cancer. Am J Gastroenterol 2001; 96: 627-629 – reference: 15) Giuliante F, Ardito F, Vellone M. Port-sites excision for gallbladder cancer incidentally found after laparoscopic cholecystectomy. Am J Surg 2006; 191: 114-116 – reference: 8) Choi SB, Han HJ, Kim CY, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 2009; 33: 2657-2663 – reference: 2) Fuks D, Regimbeau JM, Le YP Treut, et al. Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg 2011; 35: 1887-1897 – reference: 12) Goetze T, Paolucci V. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc 2006; 20: 286-293 – reference: 10) Ito H, Ito K, D'Angelica M. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg 2011; 254: 320-325 – reference: 11) Barreto SG, Pawar S, Shah S. Patterns of failure and determinants of outcomes following radical re-resection for incidental gallbladder cancer. World J Surg 2014; 38: 484-489 – reference: 7) Zhang WJ, Xu GF, Zou XP, et al. Incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy. Would J Surg 2009; 33: 2651-2656 – reference: 21) Tian YH, Ji X, Liu B, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. Would J Surg 2015; 39: 746-752 – reference: 6) Isambert M, Leux C, Metairie S. Incidentally-discovered gallbladder cancer: when, why and which reoperation? J Visc Surg 2011; 148: e77-84 – reference: 20) Choi KS, Choi SB, Park P, et al. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis. World J Gastroenterol 2015; 21: 1315-1323 – reference: 9) Shih SP, Schulick RD, Cameron JL, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2007; 245: 893-901 |
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| Snippet | ... 「要旨」: 本検討では胆嚢摘出術にて偶発的に発見される潜在性胆嚢癌の臨床病理学的特徴, 外科治療, 術後予後を明らかにすることを目的とし, 根治的手術を施行した潜在性胆嚢癌11症例, 非潜在性胆嚢癌26症例について後ろ向き観察研究を行った.... The aim is in this study to evaluate the clinicopathological characteristics, surgical procedures, and the long-term outcome of patients with incidental... |
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| SubjectTerms | incidental gallbladder carcinoma laparoscopic cholecystectomy long-term outcome lymph node dissection surgical management リンパ節郭清 外科的治療 潜在性胆嚢癌 腹腔鏡下胆嚢摘出術 長期予後 |
| Title | 潜在性胆嚢癌における外科的治療と長期予後の検討 |
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| ispartofPNX | 胆道, 2018/12/31, Vol.32(5), pp.842-848 |
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