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Titolo:
Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer
Autore:
Chijiiwa, K; Nakano, K; Ueda, J; Nishiro, H; Nagai, E; Yamaguchi, K; Tanaka, M;
Indirizzi:
Kyushu Univ, Grad Sch Med Sci, Dept Surg & Oncol, Fukuoka 8128582, Japan Kyushu Univ Fukuoka Japan 8128582 t Surg & Oncol, Fukuoka 8128582, Japan
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
fascicolo: 5, volume: 192, anno: 2001,
pagine: 600 - 607
SICI:
1072-7515(200105)192:5<600:STOPWT>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
LONG-TERM; RESECTION; STAGE; CHOLECYSTECTOMY; OPERATIONS; APPRAISAL; SURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Chijiiwa, K Kyushu Univ, Grad Sch Med Sci, Dept Surg & Oncol, Fukuoka 8128582, Japan Kyushu Univ Fukuoka Japan 8128582 ol, Fukuoka 8128582, Japan
Citazione:
K. Chijiiwa et al., "Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer", J AM COLL S, 192(5), 2001, pp. 600-607

Abstract

BACKGROUND:Because T2 carcinoma of the gallbladder that invades perimuscular connective tissue without extension beyond serosa or into the liver has a hope for longterm survival, we attempted to clarify significant prognostic factors with respect to tumor- and surgery-related variables. STUDY DESIGN:Of 65 patients with gallbladder carcinoma who had undergone surgical resection from 1983 to 1999, 28 had T2 carcinoma histologically proved. The significance of variables for survival was examined by the Kaplan-Meier method and log-rank test followed by multivariate analyses using Cox's proportional hazard model. RESULTS:There were 17 patients with stage II carcinoma (T2 N0 M0), 6 with stage III (T2 N1 M0), and 5 with stage IVB. Lymph node metastasis was present in 11patients (39%) and ir reached to the peripancreatic head region (N2) in 5 of them. Lymphatic, venous, and perineural invasions were found in 68%, 57%, and 43%, respectively. With respect to tumor factors, the absence of perineural invasion (Odds ratio [OR] 16.77, 95% confidence interval [CI] 2.17-129.94, p = 0.0069), absence of lymph node metastasis (OR 15.00, 95% CI 2.08-108.33, p = 0.0073), and stage IT (II versus III and IVB, OR 15.00, 95% CT2.08-108.33, p = 0.0073) were significant factors related to good postoperative survival in the multivariate analysis. Surgical procedure (radical resection versus cholecystectomy, OR 4.31, 95% CT 1.34-13.82, p = 0.0142) andsurgical margin (OR 7.41, 95% CI 2.19-25.13, p = 0.0013) were significant factors in the univariate analysis. Cancer-free surgical margins provided asignificantly better survival (5-year survival rate, 62%); none with cancer-positive surgical margins survived for more than 27 months. In the multivariate analysis, surgical procedure was significant (OR 25.49, 95% CI 1.62-400.72, p = 0.021). Radical surgery, including extended cholecystectomy (resection of the gallbladder together with the gallbladder bed of the liver) and anatomic resection of liver segment 5 and of the lower part of segment 4, gave a significantly better 5-year survival rate than cholecystectomy (59% versus 17%). The 5-year survival rate after radical resection in patients with stage II was 75%; that in patients with stage III and IVB was 33%. CONCLUSIONS:Results suggest that radical surgery is the treatment of choice for patients with T2 carcinoma of the gallbladder. The presence of lymph node metastasis, perineural invasion, or both suggests the necessity of additional treatment after radical surgery. (J Am Coll Surg 2001;192:600-607. (C) 2001 by the American College of Surgeons).

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 12:51:56