단순 담낭 절제술 후 확인된 담낭암에 대한 치료 근치적 재수술을 할 것인가?
Unsuspected Gallbladder Cancer Radical Second Operation vs Cholecystectomy Alone
안영준, 박윤찬, 김선회, 박용현,
소속 상세정보
안영준 ( Ahn Young-Joon )
서울대학교 의과대학 외과학교실
박윤찬 ( Park Yun-Chan )
서울대학교 의과대학 외과학교실
김선회 ( Kim Sun-Whe )
서울대학교 의과대학 외과학교실
박용현 ( Park Yong-Hyun )
서울대학교 의과대학 외과학교실
KMID : 0371320020630020146
Abstract
Purpose: This study was designed to evaluate effectiveness of additional operation for gallbladder cancers (GBC) diagnosed after simple cholecystectomy.
Methods: Retrospective pathological review of 250 GBC (Mar. 1986∼Nov. 2000) revealed that in 38 cases the malignancy had been proven by later pathologic study after the patients had initially undergone simple cholecystectomy. Twelve
patients had
a subsequent reoperation and the other 26 were observed. Types of reoperation were liver wedge resection (n=4), wedge resection with CBD resection (n=2), extended right lobectomy (n=2), wedge resection with Whipple’s operation (n=1),
hepatopancreaticoduodenectomy (n=1), bile duct resection (n=1) and open biopsy (n=1). We analyzed the clinical outcomes of these patients.
Results: (1) Patients with pT1 (n=19) survived without additional operation. (2) Five patients with pT2 lesion without reoperation and 5 patients with reoperation (LN(-): 4, LN(+): 1) were still alive without evidence of recurrence at an
average
of 35 months follow up (duration: 3∼84 months). The remaining 3 patients with reoperation (LN(+)) died at postoperative 7, 11 and 20 months. (3) One patient with pT3 cancer without LN metastasis was alive at 80 months after reoperation. (4) Among
4
patients with pT3 lesion, 3 died while the other without reoperation (unknown LN status) was alive without recurrence at 80 months after reoperation.
Conclusion: It was suggested that pT1 cancer can be treated with cholecystectomy alone. Additional operation should be applied to pT2 or more advanced cancers, and to cases of positive resection margin. Thorough gross examination of
gallbladder
specimens during cholecystectomy is essential to avoid missing hidden GBC.
키워드
우연히 발견된 담낭암; 추가적 수술; Unsuspectd gallbladder cancer; Additional operation;
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