進展度に応じた胆嚢癌の外科的治療戦略

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タイトル別名
  • Appropriate surgical strategy for gallbladder carcinoma based on the primary tumor invasion

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Although the prognostic improvement of gallbladder carcinoma requires the selection of appropriate surgical strategy compatible with curability and safety, the evidences for establishment of standard operations according to with primary tumor invasion are still insufficient.<br> In pT1 gallbladder carcinoma, lymph node metastasis has almost never been found in Japan, and good prognosis was achieved even after cholecystectomy. In cases strongly suspected pT1 gallbladder carcinoma, Japanese guideline for the biliary tract carcinomas recommends cholecystectomy under laparotomy. Although the appropriate surgical strategy can achieve a prognostic improvement in pT2 gallbladder carcinoma, its surgical procedure remains a matter of controversy. We had proposed S4a+S5 hepatic resection and combined resection of extrahepatic bile duct with D2 lymph node dissection as a standard surgical procedure for pT2 gallbladder carcinoma. In pT3 and pT4 gallbladder carcinoma, only the curative resection provides a long-term survival. Extended right hepatectomy or hepato- pancreatoduodenctomy is indicated for achievement of a curative resection. A surgical resection provided no survival benefit for the patients with peritoneal dissemination and liver metastasis.<br>

収録刊行物

  • 胆道

    胆道 26 (4), 559-569, 2012

    一般社団法人　日本胆道学会

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