关键词: 胆囊癌, 根治性切除, TNM分期

Abstract:

Status and value of radical resection in the standardized diagnosis and treatment of gallbladder carcinoma                      ZHANG Yong-jie, YU Wen-long. Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author: ZHANG Yong-jie, E-mail:510531179@
qq.com
Abstract    Surgical resection is the only curative option for patients with gallbladder cancer (GBC). According to author’s experience , lymphadenectomy around the hepatoduodenal-ligament region is recommended to ensure the curative effect. For T1b GBC, cholecystectomy with lymph node dissection is optimal, and the role of laparoscopic radical surgery remained uncertain. For T2 GBC, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed accompanied with extended lymphadenectomy around the hepatoduodenal ligament. For lesion adjacent to the GB bed, a larger extension of wedge resection is beneficial. For T3,T4 GBCs, the benefit of surgery alone is very limited. Prophylactic extrahepatic bile duct resection should not be seen as mandatory in radical operation. With respect to incidental GBC, re-operation is not required for Tis,T1a stage GBCs. However, a second radical surgery is always necessary for T1b, T2, and T3 GBCs. Especially, the trochar ports should be resected simultaneously in case of metastasis. For unresectable or recurrent GBC, radical surgery is always no longer applicable and surgical exploration is not recommended. The primary focus tends to be the improvement of life quality. The standard surgical regimens for GBC remained controversial. Large prospective studies are warranted to further improve resectability and prolong the survival.

Key words: gallbladder carcinoma, radical resection, TNM stage