Factors influencing recurrence after surgical treatment for T2 gallbladder carcinoma

BACKGROUND/AIMS: The overall outcome of T2 gallbladder carcinoma has not been favorable, although there is a modest hope for long-term survival after radical resection. The aim of this study was to examine factors influencing postoperative disease-free survival of patients with T2 gallbladder carcinoma to clarify optimal treatment. METHODOLOGY: Of 53 patients with gallbladder carcinoma who had undergone surgical resection from 1985 to 2000, 22 had T2 carcinoma histologically proved. The significance of variables for disease-free survival was examined retrospectively by the Kaplan-Meier method and the log-rank test. RESULTS: There were 16 patients with stage II (T2N0M0), 6 with stage III (T2N1M0) disease. Eleven patients were treated by extended cholecystectomy with resection of the extrahepatic bile duct, 10 patients underwent extended cholecystectomy without resection of the extrahepatic bile duct, and 1 patient underwent cholecystectomy. All patients underwent lymph node dissection in the hepatoduodenal ligament, below the pancreatic head, and along the common hepatic artery. Lymph node metastasis was present in 6 patients. Lymphatic, venous, and perineural invasions were found in 9, 4, and 4 patients, respectively. The absence of lymphatic invasion was a significant factor related to good postoperative disease-free survival (5-year disease-free survival rate, 88.9% vs. 31.3% in the presence of lymphatic invasion). Lymph node, venous, or perineural invasion, and surgical procedure were not significant factors to good postoperative disease-free survival. CONCLUSIONS: For patients with T2 gallbladder carcinoma, the presence of lymphatic invasion is an unfavorable prognostic indicator that calls for additional treatment after radical surgery.     

Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment

The only curative treatment in biliary tract cancer is surgical treatment. Therefore, the suitability of curative resection should be investigated in the first place. In the presence of metastasis to the liver, lung, peritoneum, or distant lymph nodes, curative resection is not suitable. No definite consensus has been reached on local extension factors and curability. Measures of hepatic functional reserve in the jaundiced liver include future liver remnant volume and the indocyanine green (ICG) clearance test. Preoperative portal vein embolization may be considered in patients in whom right hepatectomy or more, or hepatectomy with a resection rate exceeding 50%–60% is planned. Postoperative complications and surgery-related mortality may be reduced with the use of portal vein embolization. Although hepatectomy and/or pancreaticoduodenectomy are preferable for the curative resection of bile duct cancer, extrahepatic bile duct resection alone is also considered in patients for whom it is judged that curative resection would be achieved after a strict diagnosis of its local extension. Also, combined caudate lobe resection is recommended for hilar cholangiocarcinoma. Because the prognosis of patients treated with combined portal vein resection is significantly better than that of unresected patients, combined portal vein resection may be carried out. Prognostic factors after resection for bile duct cancer include positive surgical margins, especially in the ductal stump; lymph node metastasis; perineural invasion; and combined vascular resection due to portal vein and/or hepatic artery invasion. For patients with suspected gallbladder cancer, laparoscopic cholecystectomy is not recommended, and open cholecystectomy should be performed as a rule. When gallbladder cancer invading the subserosal layer or deeper has been detected after simple cholecystectomy, additional resection should be considered. Prognostic factors after resection for gallbladder cancer include the depth of mural invasion; lymph node metastasis; extramural extension, especially into the hepatoduodenal ligament; perineural invasion; and the degree of curability. Pancreaticoduodenectomy is indicated for ampullary carcinoma, and limited operation is also indicated for carcinoma in adenoma. The prognostic factors after resection for ampullary carcinoma include lymph node metastasis, pancreatic invasion, and perineural invasion.     

Clinical results and prognostic factors of radiologically node-positive gastric carcinoma

Lymph node metastasis determined by histologic examination is an important prognostic indicator in gastric carcinoma. However, prognostic value of lymph node metastasis detected by computed tomography (CT) is unknown. The aim of this study was to evaluate clinical results and prognostic factors of patients with radiologically node-positive gastric carcinoma. The study included 78 patients with primary gastric carcinoma and lymph node metastasis confirmed by CT. The level of lymph node metastasis was simply graded as follows: level I included perigastric nodes; level II included intermediate nodes along the left gastric, common hepatic, and celiac arteries; and level III included distant nodes along the hepatoduodenal ligament, pancreas, spleen, and abdominal aorta. Sixty patients (79%) had stage IV tumors showing one or more of the following: level III lymph node metastasis in 37, pancreatic invasion in 27, peritoneal dissemination in 23, and liver metastasis in 19. Overall 1- and 5-year survival rates were 29% and 6%, respectively, and the 1-year survival rate was significantly influenced by the level of lymph node metastasis on CT (55% for level I, 27% for level II, 7% for level III, P < 0.01). In patients with gastrectomy, prognostic factors were tumor size (<10 cm versus >10 cm, P < 0.01), gross type (localized versus infiltrative, P < 0.01), histologic type (well differentiated versus poorly differentiated, P < 0.01), and curability of the disease (curative versus noncurative, P < 0.01). Our study indicates that prognosis of patients with radiologically node-positive gastric carcinoma is poor because of high frequency of extensive tumor spreads. Patients having only positive level I nodes on CT are candidates for curative gastrectomy, which may offer long-term survival.     

Long-term results of central inferior (S4a+S5) hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy for gallbladder carcinoma with subserous or mild liver invasion (pT2-3) and nodal involvement: a preliminary report

BACKGROUND/AIMS: Gallbladder carcinoma, especially advanced cancer that has invaded the subserosal or deeper layers, has a poor prognosis. Recently, radical operations combining resection of the liver and pancreas with extended lymph node dissection have been introduced to improve the prognosis of advanced gallbladder carcinoma. We have introduced central inferior (Couinaud's subsegments 4a and 5; S4a+S5) hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy for gallbladder carcinoma demonstrating subserous or mild liver invasion (pathological tumor stage pT2-3) and nodal involvement. METHODOLOGY: Morbidity, mortality, clinicopathological features, and long-term outcome were analyzed retrospectively for seven consecutive patients who underwent this radical operation. RESULTS: The postoperative morbidity rate was 57.1% and there was no surgical mortality. All patients had lymph node involvement: two had pN1 disease and five had pN2 disease. All patients underwent curative resection. Only one patient developed gallbladder carcinoma recurrence after resection and it involved the paraaortic lymph nodes. Five patients, three of whom displayed pN2 disease, survived longer than 5 years postoperatively with no evidence of disease. CONCLUSIONS: S4a+S5 hepatic subsegmentectomy and pancreatoduodenectomy combined with extended lymphadenectomy improve the long-term survival of gallbladder carcinoma with pT2-3 and nodal involvement. The presence of pN2 disease is not a contraindication for surgery. Further study is necessary to evaluate the usefulness of this radical procedure, especially as a standard operation.     

Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer

PURPOSE: Lymph node metastasis in the hepatoduodenal ligament is known as one of the most significant prognostic factors after liver resection for colorectal metastasis. However, there have been very few articles on the clinical features of node-positive patients and on detailed distribution of positive nodes. Further, there has been no established strategy on how to handle hepatic lymph nodes during liver resection. To address these subjects, a retrospective study was conducted. METHODS: During the period of 1980 through April 1998, 182 hepatic resections were performed for metastatic colorectal carcinoma. Of these, 78 cases had hepatic lymph node sampling during the operation. Distribution of positive nodes, location of liver metastasis, stage of the primary lesion, and outcome after liver resection were analyzed. RESULTS: Nine cases (12 percent) had secondary lymph node metastases in the hepatoduodenal ligament. The incidence was slightly higher (13.5 percent) in the most recent 44 consecutive cases. There was a tendency for liver metastases in the right lobe to metastasize to No. 12b (or node of the foramen of Winslow, lymph nodes along the common bile duct) and liver metastases in the left lobe to metastasize to No. 8a (anterosuperior group of the lymph nodes along the common hepatic artery). Outcome of node-positive patients (n=9) was extremely poor (P<0.001) compared with that of node-negative patients (n=66), and the most common site of recurrence in the node-positive patients was remnant liver and hepatic lymph nodes. Preoperatively, there were no significant predicting factors for positive hepatic lymph nodes. CONCLUSIONS: No. 8a and No. 12b nodes are principal nodes that should be palpated and sampled during liver resection to check the secondary lymphatic spread from liver metastases. Hepatic nodal involvement indicates the progression of disease beyond simple liver metastases and may not be the indication for simple surgical removal. Further study, including hepatoduodenal dissection and systemic adjuvant chemotherapy, may elucidate the survival benefit, if any, of liver resection in node-positive patients.     

Analysis of the prognostic factors for liver metastasis of gastric cancer after hepatic resection: a multi-institutional study of the indications for resection

BACKGROUND/AIMS: The number of reports of hepatic resection for metastatic gastric cancer is very small. The outcome and indications of hepatic resection for metastatic gastric cancer remains unknown. METHODOLOGY: A multi-institutional study was made. Thirty-six patients who underwent a hepatic resection for liver metastasis of gastric cancer with no residual tumor were included in this study. The clinicopathological factors were examined as prognostic factors by multivariate analyses. Thirty patients had recurrence and the recurrence pattern and risk factors for extrahepatic recurrence was examined. RESULTS: The overall survival rate was 64% at 1 year, 43% at 2 years, 26% at 3 years 26% at 5 years, and 26% at 10 years after hepatectomy. Multivariate analysis showed that lymphatic invasion, venous invasion of cancer cells of primary gastric cancer and the number of the liver metastasis (> 3) were independent poor prognostic factors after hepatic resection. The most common recurrence pattern was intrahepatic recurrence in 22 patients (73%). The risk factors for extrahepatic recurrence was serosal invasion, lymph node metastasis of primary gastric cancer, stage, and curability of operation. CONCLUSIONS: Hepatic resection for liver metastasis should be attempted in case primary gastric cancer has neither lymphatic invasion nor venous invasion. The most common recurrent site was the liver. In patients with advanced gastric cancer, having neither serosal invasion nor lymph node metastasis, who underwent a less curative operation, the intra-hepatic recurrence would be expected. Thus, aggressive adjuvant chemotherapy through the hepatic artery may improve the survival after hepatectomy in these patients.     

Adenosquamous carcinoma of the gallbladder

BACKGROUND/AIMS: Adenosquamous carcinoma of the gallbladder is relatively rare. Its biological behavior and optimal surgical procedure are still controversial. METHODOLOGY: Clinicopathological factors and proliferating cell nuclear antigen expression were studied in four stage IV adenosquamous carcinoma patients who underwent curative surgery between June 1987 and April 2000, comparing those of 14 stage IV adenocarcinoma patients at the same period. RESULTS: Preoperative radiological evaluation disclosed a mass invading to the adjacent organs in all cases (liver in 3 cases, and liver and stomach in one case). Three patients (case 1, 2 and 3: well-differentiated adenosquamous carcinomas) were all alive without recurrence in 10, 7, and 2 years after surgery. In contrast, the remaining patient (case 4: moderately differentiated adenosquamous carcinoma) with positive pathologic factors (lymph node metastasis, vascular invasion, etc) deceased one year after surgery due to peritoneal dissemination. When survival rate of adenosquamous carcinoma was compared, the prognosis of adenosquamous carcinoma was significantly better than that of adenocarcinoma (P = 0.0103). Comparison of pathological factors revealed that the frequency of lymph node metastasis was significantly higher in adenocarcinoma than in adenosquamous carcinoma (P = 0.004). Consistent with these findings, the positivity rate of proliferating cell nuclear antigen labeling was significantly lower in squamous carcinoma component, compared with adenosquamous component (P < 0.0001) or adenocarcinoma (P < 0.0001). CONCLUSIONS: Even in patients with stage IV adenosquamous carcinoma of the gallbladder, a long-term survival may be obtained by curative surgery if the squamous component is predominant.     

Prediction of survival period for patients with postoperative recurrence after curative resection for advanced gastric carcinoma

BACKGROUND/AIMS: Although many studies have attempted to clarify the prognostic indicators for gastric carcinoma, there have been few studies regarding the factors that correlate with the survival period of patients with postoperative recurrence. METHODOLOGY: Among 504 advanced gastric adenocarcinoma patients who had undergone curative gastrectomy, 188 patients who had died of recurrence were used in this study. RESULTS: Univariate analysis indicated that age, the presence of lymph node metastasis and blood vessel invasion, the number of positive lymph nodes, and gastrectomy significantly correlated with the survival period. Multivariate analysis indicated that the length of the survival period was independently influenced by the number of positive lymph nodes and blood vessel invasion. The survival time of patients with less than 3 positive lymph nodes and no accompanying blood vessel invasion was significantly longer than that of other patients. CONCLUSIONS: The number of positive lymph nodes and the presence of blood vessel invasion are the most important factors predicting the survival period of patients with postoperative recurrence after curative resection for advanced gastric carcinoma.     

Multivariate statistical analysis of clinicopathologic factors influencing survival of patients with bile duct carcinoma

AIM：To evaluate the influence of various clinicopathologic factors on survival of patients with bile duct carcinoma after cuative resection.METHODS:A retrospective analysis was made for 86cases of bile duct carcinoma treated from January 1981to September1995,Fifteen clinicopathologic factors possibly influencing survival were selected.Independent variables were first analyzed by univariate methods.Survival for variable was estimated by the method of Kaplan and Meier.The variables that were statistically significant by univariate analysis were included in a multivariate analysis,which were confirmed using the Cox stepwise proportion hazard model with the help of SPSS10.0for Windows software.RESULTS:The overall cumulative survival rate was72.6%at 1year,32.4%at3years,and18.7%at5years,The results of univariate analysis showed that the major significant prognostic factors influencing survival of these patients were histological type of lesion.lymap node metastasis,pancreatic invasion.duodenal invasion,perineural invasion,macroscopic vessel involvement,resected surgical margin and depth of cancer invasion(P=0.02,0.02,0.004,0.005,0.01,0.43,0.03and0.04).Age,sex,location of tumor,size of tumor,macroscopic type of lesions,hepatic metastasis,and hepatic invasion were n ot significantly associated with prognosis(P&gt;0.05).Pancreatic invasion.perineural invasion and lymph node metastases were the three most imprtant prognostic factors by multivariate analysis using the Cox proortional hazards model.CONCLUSION;Pancreatic invasion.perineural invasion and lymph node metastases are the most important prognostic factors for bile duct carcinoma after curative resection.     

Prognostic factors of intrahepatic cholangiocarcinoma after hepatic resection: univariate and multivariate analysis

BACKGROUND/AIMS: Intrahepatic cholangiocarcinoma is clinicopathologically distinct from hepatocellular carcinoma and hilar cholangiocarcinoma, and the prognostic factors after hepatic resection of these rare tumors are not well documented. The aim of this study was to evaluate prognostic factors of intrahepatic cholangiocarcinoma after hepatic resection. METHODOLOGY: We retrospectively studied 20 consecutive patients with intrahepatic cholangiocarcinoma who underwent hepatectomy over a 15-year period from 1984 to 1998. Fifteen prognostic factors were evaluated for their association with overall and disease-free survivals in univariate and multivariate analysis (Cox's proportional hazards model). RESULTS: Eighty percent of the resected patients had major hepatectomy. Operative morbidity and mortality rates were 30% and 0%, respectively. Four patients (20%) survived more than 5 years without recurrence after hepatic resection. The 1-year, 3-year, and 5-year overall or disease-free survival rate after hepatic resection were 56.0% or 49.5%, 43.8% or 43.3%, and 43.8% or 37.3%, respectively. Univariate analysis showed young age and periductal invasion tumor or the presence of vascular invasion, lymphatic invasion, and lymph node metastasis as significant poor prognostic predictors contributing overall and disease-free survivals. Multivariate analysis revealed only lymph node metastasis as an independent prognostic factor affecting disease-free survival. During the same time, 17 unresectable patients were treated by intrahepatic arterial infusion chemotherapy (12), systemic chemotherapy (4), or radiation (1). Median overall survival time in resected patients (16 months) was significantly better than in unresectable patients (5 months) (P = 0.005). CONCLUSIONS: Hepatic resection remains to be the best current therapeutic option. The prognosis after hepatic resection for intrahepatic cholangiocarcinoma was determined by lymph node metastasis. New adjuvant chemotherapy after surgery is imperative for such patients.     

Impact of lymph node micrometastasis in hilar bile duct carcinoma patients

AIM: To immunohistochemically examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma (HBDC) and to evaluate the clinical significance of the results. METHODS: A total of 361 regional lymph nodes from 25 patients with node-negative HBDC were immunostained with an antibody against cytokeratins 8 and 18 (CAM 5.2), and immunohistochemical staining of VEGF-C was performed in 34 primary resected tumors. RESULTS: Lymph node micrometastasis was detected in 6 (24%) of the 25 patients and 10 (2.8%) of the 361 lymph nodes. Patients with micrometastasis showed significantly poorer survival rates than those without (P=0.025). VEGF-C expression was positive in 17 (50%) of 34 HBDC, and significantly correlated with lymph node metastasis (P=0.042) and microscopic venous invasion (P=0.035). CONCLUSIONS: It is suggested that immunohistochemically detected lymph node micrometastasis has an impact on the outcome of HBDC. VEGF-C expression is highly correlated with lymph node metastasis in HBDC and might therefore be a useful predictor.     

Hepatopancreatoduodenectomy with wide lymph node dissection for locally advanced carcinoma of the gallbladder--long-term results

BACKGROUND/AIMS: Although hepatopancreatoduodenectomy with wide lymph node dissection has been conducted for patients with locally advanced gallbladder carcinoma, the clinical usefulness of this radical procedure has not yet been estimated. METHODOLOGY: Morbidity, mortality, and outcome were analyzed retrospectively for 16 consecutive patients undergoing hepatopancreatoduodenectomy. RESULTS: One in-hospital fatality (6.3%) and 11 postoperative complications occurred (69%). Overall 5-year survival in this procedure was 42.9%. The 5-year survival of patients undergoing potentially curative resection (52.7%) was significantly better (P = 0.016) than those with residual tumor (0%). There was no significant correlation in 5-year survival between patients with and without lymph node metastasis. Five patients (31%) survived 5 years. Of these, 4 had Stage IVB disease, and 2 had pN2 disease. Two patients with pM1 (lymph) disease died of the disease 6 months and the other 7 months after surgery, respectively. CONCLUSIONS: Hepatopancreatoduodenectomy with wide lymph node dissection is an effective treatment for the selected patients with locally advanced gallbladder carcinoma with until pN2 disease, if curative resection is potentially feasible. Surgery is not indicated in those with pM1 (lymph) disease.     

Surgical outcome of curative resection in patients with Borrmann type IV gastric carcinoma with particular reference to the extent of lymph node metastasis

BACKGROUND/AIMS: The prognosis after curative resection for Borrmann type IV carcinoma, according to the extent of lymph node metastasis, is poorly understood. METHODOLOGY: The surgical outcome of curative resection was examined in 78 patients with T2-T3 Borrmann type IV gastric carcinomas, with particular reference to the extent of lymph node metastasis. RESULTS: The 5-year survival rate was 35.7% for the n0 patients, 27.8% for the n1 patients, 18.2% for the n2 patients and 0% for the n3 or n4 patients. The survival curve for the n3 or n4 patients differed significantly from those of the n0 (P < 0.0001), n1 (P = 0.0009) and n2 (P = 0.0203) patients. However, no other statistically significant differences between the curves were found. CONCLUSIONS: The results of the present study indicate that patients with Borrmann type IV carcinoma of the stomach may indeed be cured by curative surgery, and that the surgical outcome of this disease does not depend on the extent of lymph node metastasis under curative resection if lymph node metastasis is restricted to the n2 lymph nodes.     

Outcome of radical surgery for stage IV gallbladder carcinoma

Background/Purpose

The role of aggressive surgery for patients with stage IV gallbladder carcinoma was examined.

Methods

Cancers were classified according to the TNM system of the Japanese Society of Biliary Surgery. The survival of 37 patients with stage IV cancer (stage IVa, n = 15; stage IVb, n = 22) treated by surgical resection during the period January 1990 to December 2004 was examined and compared with the survival of 41 patients with stage IV disease not treated by surgical resection during the same period.

Results

The postoperative survival rate was significantly better for patients with resected stage IVa cancer than for patients with resected stage IVb disease and for those with nonresected stage IV disease. Survival in patients with N3 lymph node metastasis, liver metastasis, peritoneal dissemination, or vascular invasion was poor, like that in the nonresected group. Surgical resection without residual tumors (curability A and B) yielded a significantly better outcome than that with residual tumor (curability C). There were three 5-year survivors that were treated successfully by curative resection (curability A and B) and all had T4N0 disease.

Conclusions

These results suggest that surgical resection significantly improves survival even in patients with stage IV gallbladder carcinoma when N3 metastasis, liver metastasis, peritoneal dissemination, and vascular invasion are absent. Curative resection can be expected to produce long-term survival in selected patients with stage IV gallbladder carcinoma.

     

Retrospective analysis of outcome in 63 gallbladder carcinoma patients after radical resection

Background/Purpose

The aim of this study was to evaluate factors influencing outcome in gallbladder carcinoma after radical resection, in order to identify those patients benefiting from radical surgery.

Methods

Sixty-three patients (13 pT1, 28 pT2, 14 pT3, and 8 pT4) who underwent surgical resection for gallbladder carcinoma were retrospectively reviewed. Correlations were sought between survival and factors such as the depth of invasion (pT) including the status of infiltration of the hepatoduodenal ligament (pBinf) and liver bed (pHinf), the extent of lymph node metastasis, and other pathologic factors.

Results

Multivariate analysis showed that pBinf, pHinf, and lymph node metastasis were significant prognostic factors. We also analyzed survival rates for each operative procedure. There was no difference in survival between patients with or without bile duct resection for lymph node metastasis. The 5-year survival rates of pHinf-negative patients with stage 1B or more advanced disease after gallbladder bed resection or bisegmentectomy 4a,5 versus those without liver resection were 66% and 0%, respectively. Twelve patients survived for more than 5 years after surgery, including one patient undergoing HPD (liver resection with pancreatoduodenectomy) with positive lymph node metastasis; none was pBinf-positive.

Conclusions

Several factyors were identified as having prognostic significance for survival in patients with gallbladder carcinomas, and we suggest that radical surgery may be indicated for selected patients with advanced disease.     

Clinical significance of subcellular localization of KL-6 mucin in primary colorectal adenocarcinoma and metastatic tissues

AIM:To assess subcellular localization of KL-6 mucinand its clinicopathological significance in colorectalcarcinoma as well as metastatic lymph node and livertissues.METHODS:Colorectal carcinoma tissues as wellas metastatic lymph node and liver tissues werecollected from 82 patients who underwent colorectomyor hepatectomy.Tissues were subjected toimmunohistochemical analysis using KL-6 antibody.RESULTS:Of the 82 colorectal carcinoma patients,6showed no staining,29 showed positive staining only inthe apical membrane,and 47 showed positive stainingin the circumferential membrane and/or cytoplasm.Positive staining was not observed in non-cancerouscolorectal epithelial cells surrounding the tumor tissues.The five-year survival rate was significantly lower incases showing positive staining in the circumferentialmembrane and/or cytoplasm (63.0%) than thoseshowing positive staining only in the apical membrane(85.7%) and those showing no staining (100%).Statistical analysis between clinicopathological factorsand subcellular localization of KL-6 mucin showed thatKL-6 localization in the circumferential membrane and/or cytoplasm was significantly associated with the presenceof venous invasion (P=0.0003),lymphatic invasion(P<0.0001),lymph node metastasis(P<0.0001),liver metastasis (P=0.058),and advanced histologicalstage(P<0.0001).Positive staining was observed inall metastatic lesions tested as well as in the primarycolorectal carcinoma tissues.CONCLUSION:The subcellular staining pattern ofKL-6 in colorectal adenocarcinoma may be an importantindicator for unfavorable behaviors such as lymph nodeand liver metastasis,as well as for the prognosis ofpatients.     

原发性胆囊癌组织中脆性组氨酸三联体基因和Ki-67的表达及临床意义

目的:探讨脆性组氨酸三联体(FHIT)基因和Ki-67抗原在原发性胆囊癌、胆囊腺瘤和慢性胆囊炎组织中的表达情况.方法:应用免疫组织化学S-P法,检测51例原发性胆囊癌、15例胆囊腺瘤和12例慢性胆囊炎组织中FHIT和Ki-67的表达情况,并分析其与胆囊癌临床病理因素的关系.结果:胆囊癌组中FHIT阳性率明显低于胆囊腺瘤和慢性胆囊炎组(47.1%vs66.7%,91.7%,P<0.01),而Ki-67阳性率明显高于胆囊腺瘤和慢性胆囊炎组(82.4%vs20.0%,0,P<0.01).FHIT表达缺失不仅与胆囊癌的高分级(18.8%vs56.5%,66.7%,P=0.02)、淋巴结或远处转移(33.3%vs66.7%,P=0.019)明显相关,而且与术后生存时间减少关系密切(31.2%vs77.8%,P=0.041).Ki-67表达与胆囊癌的高分级(58.3%vs87.0%,93.8%,P=0.039)和淋巴结或远处转移(33.3%vs66.7%,P=0.037)明显相关.FHIT与Ki-67表达呈负相关(r=-0.285,P=0.043).结论:FHIT基因是胆囊癌的一个候选抑癌基因.FHIT和Ki-67在胆囊癌的发生和演化中均起着重要作用,联合检测FHIT和Ki-67的表达情况有助于临床评估胆囊癌的生物学行为和判断预后.     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Proposal on the extent of lymph node dissection for gallbladder carcinoma.

BACKGROUND/AIMS: To evaluate the value of performing extended regional lymph node dissection for gallbladder carcinoma, the mode of recurrence after curative resection was analyzed. METHODOLOGY: Records of 45 patients who underwent surgical resection for gallbladder carcinoma from 1973 to August 1997 were reviewed. RESULTS: Thirty-three cases underwent a curative resection and 12 received a non-curative resection. Among the 32 patients who survived the curative resection, cancer recurred in 7 with lymph node metastasis, whereas recurrence was found in only 1 of the remaining 25 patients without lymph node metastasis (p < 0.0001). At the 1st diagnosis of recurrence in these 8 patients, lymph node recurrence was detected in 7, and the site of recurrence was limited to the lymph nodes, which were confined to the peripancreatic region and the interaortocaval nodes near the left renal vein in 4 cases. CONCLUSIONS: In view of the site of the metastatic lymph nodes and the lymphatic drainage system of the gallbladder, it was considered that lymph node dissection was inadequate in 5 of the 8 patients and that 2 might have been cured by extended regional lymph node dissection, including complete resection of the retroportal, posterior pancreatoduodenal, right celiac and interaortocaval nodes.