J.Jpn. Surg. Soc.. 88(9): 1339-1342, 1987
Report on the annual meeting
THE TREATMENT OF ADVANCED GALLBLADDER CARCINOMA FROM THE VIEW POINT OF TUMOR SPREADING MODES
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First Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan Akira Kakita, Masaaki Kambayashi, Masatoshi Takahashi, Hiroshi Shiroto, Tsuyoshi Takahashi, Yutaka Saji, Junichi Uchino |
Eleven cases, with tumor invasion limited in proper muscle layer showed no tumor invasive factors such as lymphatics (ly), veins (v), perineural space (pn), and microscopic lymph nodes metastasis. Five year survival rate of them after surgery was 100％. Seventeen cases with tumor invasion limitted in subserosal layer were found to have each tumor invasive factors (ly, v, pn, n) in 58.8％, 35.3％, 35.3％, and 23.5％, respectively. Five year survival rate was 58％.
The positive rate of tumor invasive factors (ly, v, pn, n) in cases with serosal invasion (11 cases) were 100％, 81％, 81％, and 91％, respectively. There are no survived cases beyond two years in this group.
The glycoprotein staining (Fibronectin, Raminin, Type IV collagen) which chiefily composed the basement menbrane (BM) was done in selected cases to examine the tumor metastatic ability. The staining of the cases with tumor invasion limitted in mucosal layer was same as the benign tumors, but the cases with the tumor invasion beyond the serosal layer showed poor staining of BM.
It is concluded that the pathophysiological status of gall-bladder carcinoma was clearly determined by tumor spreading in depth. So called advanced gallbladder carcinoma should be the case with tumor invasion beyond subserosal layer. The treatment of the advanced cases should be extended surgery, including at least extrahepatic bile duct resection with systemic radical lymph node dissection.
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