Abstract
We evaluated extended cholecystectomy, wedge resection of the gallbladder bed, and regional lymphadenectomy for carcinoma of the gallbladder. Between 1971 and 1993 we treated 227 patients, 59 of whom were treated with simple cholecystectomy and 66 with extended cholecystectomy. The tumors were classified according to the stages proposed by the Japanese Society of Biliary Surgery. For Stage I and II discase extended cholecystectomy had a better result than simple cholecystectomy. For the extended cholecystectomy cases the cumulative 5-year survival rate was 78.9% for Stage I, 63.6% for Stage II, 44.4% for Stage III, and 8.3% for Stage IV. The survival of Stage I patients was excellent. For cases more advanced than Stage II (S3, N2, Hinf1, and Binf1), the prognosis was significantly worse. In these cases more aggressive surgery may be needed.
Résumé
Nous avons évalué la choléystectomie étendue, c'est à dire combinée à une résection en coin du lit vésiculaire et une lymphadénectomie régionale, pour cancer de la vésicule biliaire. Entre 1971 et 1993, 227 cas de cancer de la vésicule ont été traités. Parmi ceux-ci, 59 ont eu une simple cholécystectomie et 66 ont eu une choléystectomie «étendue». Les tumeurs ont été classées par la Société Japonaise de la Chirurgie Biliaire. Dans les stades I et II, l'évolution après la chlécystectomie étendue a été meilleure qu'après la cholécystectomie simple. La survie cumulative à 5 ans a été, respectivement dans les stades I, II, III et IV, de 78.9%, 63.6%, 44.4%, et 8.3. La survie chez les patients stade I est excellente. Dans les stades II, III, et IV, S3, N2, Hinf1 et Binf1, le pronostic est nettement moins bon. C'est dans ces cas qu'une chirurgie plus agressive est indiquée.
Resumen
Hemos estudiado el procedimiento de colecistectomía ampliada, resección en cuña del lecho vesicular y linfadenectomía regional en el tratamiento del carcinoma de la vesícula biliar. En el período 1971 a 1993, se trataron 227 casos, de los cuales 59 fueron sometidos a colecistectomía simple y 66 al procedimiento ampliado. Los tumores fueron clasificados de acuerdo con la estadificación propuesta por la Sociedad Japonesa de Cirugía Biliar. En los estados I y II, la colecistectomía ampliada demostró un mejor resultado que la colecistectomía simple. En los casos de colecistectomía ampliada, la tasa acumulada de sobrevida a 5 años fue 78.9% en el estado I, 63.6% en el estado II, 44.4% en el estado III y 8.3% en el estado IV. La tasa de sobrevida en el estado I fue excelente. En los casos con tumores más avanzados que el estado II, S3 N2 Hinf1 y Binf1, el pronóstico fue significativamente peor. En estos casos puede ser necesaria una conducta quirúrgica más agresiva.
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Onoyama, H., Yamamoto, M., Tseng, A. et al. Extended cholecystectomy for carcinoma of the gallbladder. World J. Surg. 19, 758–763 (1995). https://doi.org/10.1007/BF00295925
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DOI: https://doi.org/10.1007/BF00295925