胆嚢癌S<SUB>0</SUB>症例の壁深達度診断と手術方針 [in Japanese] Diagnosis and management for cancer of the gallbladder without invasion of serosa macroscopically (S<SUB>0</SUB>) [in Japanese]
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The records of 20 patients, who had cancer of the gallbladder without invasion of serosa macroscopically at the operation were analysed. In all patients the gallbladder were resected and examined microscopically. Cancer was limited to muscularis in 8 patients (m in 6 patients, pm in 2 patients) and had spread beyond the muscle layer in 12 patients (ss in 8 patients, se in 4 patients). Lymphnodal metastases, lymphatic permeation and venous permeation were negative in m and pm patients. But in ss and se patients those permeation were found with high rate. The survival rates of the S<SUB>0</SUB> patients were computed by Kaplan & Meier's method. The 5-year survival rates were 100% in m and pm patients, 16% in ss patients and 30% in se patients. The patients whose lesions had spread beyond the muscle layer showed poor results.<BR>Intraoperative ultrasonographic examination was performed in 10 patients for diagnosis of invasion to the wall of the gallbladder. A correct diagnosis had been made in 9 of 10 patients.<BR>When cancer is diagnosed not to invade beyond the muscle layer by intraoperative ultrasonography, extended cholecystectomy (composed of resection of the gallbladder and wedgeshape resection of the liver and dissection of the cystic lymph node and the pericholedochal lymph nodes) should be performed. And if cancer is diagnosed to invade beyond the muscle layer, extended cholecystectomy combined with resection of the bile duct and regional lymph nodes (n<SUB>2</SUB>) should be performed. Segmentectomy (S<SUB>4</SUB>, S<SUB>5</SUB>) of the liver combined with pancreatoduodenectomy should be performed if lymphnodal (n<SUB>2</SUB>) and liver involvement is found at the operation.
Tando 1(1), 61-68, 1987
Japan Biliary Association