拡大リンパ節郭清の功罪　胆嚢癌に対する拡大リンパ節郭清の功罪

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  • The Advantages and Disadvantages of Lymphadenectomy for Gallbladder Cancer.

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The aim of this study was to clarify the advantages and disadvantages of lymphadenectomy for gallbladder cancer. One hundred fifty seven gallbladder cancer, resected with microscopically cancer free surgical margins, were studied. The surgical results for each depth of cancer invasion were examined and recorded according to the General Rules for Surgical and Pathological Studies on Cancer of the Biliary Tract (Japanese Society of Biliary Surgery) M cancer (35 cases): No lymph node metastasis was founded and no patient died even among those with R-number. Pm cancer (7 cases): Lymph node metastasis in the fi rst barrier of the lymph node was seen in 1 patient. Advanced cancers (115 cases with ss, se or si): The rate of operative deaths was 0% in RO, 4.4% in Rl, 2, and 14% in R3. The rate of the operative deaths was correlated with R-number. R3 (n=13) lymphadenectomy only for the cases with binf (-) n (+) fielded a better 5-year survival rate than that for Rl, 2 (n=9). The survival rate for R3 was 70%, whereas that for Rl, 2 was 26%. We concluded that for advanced cancer, extended R3 lymphadenectomy is especially effective for the cases with n (+) binf (-) and a cancer free-surgical margin, whereas the disadvantage of extended R3 lymphadenectomy was the high operative mortality compared to R2 or more reduction lymphadenectomy.

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