胆囊癌手术治疗的现状与进展

殷晓煜; 许琼聪

doi:10.12449/JCH241205

胆囊癌手术治疗的现状与进展

DOI: 10.12449/JCH241205

殷晓煜^, ,,
许琼聪

中山大学附属第一医院胆胰外科，广州 510080

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：殷晓煜负责课题设计，拟定写作思路，指导撰写文章并最后定稿；许琼聪负责资料收集分析，撰写论文，修改论文。

详细信息

通信作者:
殷晓煜， yinxy@mail.sysu.edu.cn （ORCID： 0000-0002-5518-5984）

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出版历程
- 收稿日期: 2024-10-15
- 录用日期: 2024-10-25
- 出版日期: 2024-12-25

Surgical treatment of gallbladder cancer： Current status and advances

Xiaoyu YIN^{,
,},
Qiongcong XU

Department of Pancreatobiliary Surgery，The First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，China

More Information

Corresponding author: YIN Xiaoyu， yinxy@mail.sysu.edu.cn （ORCID： 0000-0002-5518-5984）

摘要

摘要: 胆囊癌是一种预后极差的恶性肿瘤，根治性手术切除仍然是其唯一有治愈希望的治疗手段。对于Tis、T1a期胆囊癌，单纯胆囊切除即可达到治愈效果；对于T1b～T2期胆囊癌，胆囊癌根治术（包括胆囊及肝部分切除和区域淋巴结清扫）是首选方式；对于T3～T4期患者，扩大根治术有可能改善部分患者的预后，但手术风险大、并发症发生率高，需要严格把握其适应证，并建议由经验丰富的肝胆胰外科团队实施。微创手术在胆囊癌手术治疗中的应用价值目前仍存在较多的争议，但越来越多的证据表明，在微创手术经验丰富的医学治疗中心，胆囊癌微创手术是安全可行的。本文在临床实践经验的基础上结合文献报道系统地阐述胆囊癌手术治疗现状与进展。
- 胆囊肿瘤 /
- 外科手术 /
- 治疗学
Abstract: Gallbladder cancer is a malignant tumor with an extremely poor prognosis， and radical surgery remains the only potentially curative treatment method for this disease. For stage Tis and T1a gallbladder cancer， cholecystectomy alone can achieve a curative effect； for stage T1b-T2 gallbladder cancer， radical surgery （including resection of the gallbladder， partial hepatectomy， and regional lymphadenectomy） remains the preferred treatment modality； for stage T3-T4 gallbladder cancer， extended radical resection helps to improve the prognosis of some patients， but with a high risk and a high incidence rate of complications， and it is necessary to grasp the indications and conduct surgery by a team with rich experience in pancreatobiliary surgery. There are currently still controversies over the application of minimally invasive surgery in the treatment of gallbladder cancer； however， an increasing number of evidence has shown that minimally invasive surgery for gallbladder cancer is safe and feasible in centers with extensive experience in minimally invasive techniques. This article systematically elaborates on the current status and advances in the surgical treatment of gallbladder cancer based on the authors’ clinical experience and related articles.
- Gallbladder Neoplasms /
- Surgical Procedures， Operative /
- Therapeutics

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参考文献(44)

[1]	MISRA S, CHATURVEDI A, MISRA NC, et al. Carcinoma of the gallbladder[J]. Lancet Oncol, 2003, 4( 3): 167- 176. DOI: 10.1016/s1470-2045(03)01021-0.
[2]	HUNDAL R, SHAFFER EA. Gallbladder cancer: Epidemiology and outcome[J]. Clin Epidemiol, 2014, 6: 99- 109. DOI: 10.2147/CLEP.S37357.
[3]	SHAFFER EA. Gallbladder cancer: The basics[J]. Gastroenterol Hepatol(N Y), 2008, 4( 10): 737- 741.
[4]	DI MAURO D, ORABI A, MYINTMO A, et al. Routine examination of gallbladder specimens after cholecystectomy: A single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma[J]. Discov Oncol, 2021, 12( 1): 4. DOI: 10.1007/s12672-021-00399-5.
[5]	LI B, ZOU WL, ZUO S. Advances and challenges in surgical management of unexpected gallbladder cancer[J]. J Clin Surg, 2022, 30( 11): 1016- 1019. DOI: 10.3969/j.issn.1005-6483.2022.11.005. 李博, 邹卫龙, 左石. 意外胆囊癌外科治疗的进展和挑战[J]. 临床外科杂志, 2022, 30( 11): 1016- 1019. DOI: 10.3969/j.issn.1005-6483.2022.11.005.
[6]	FUKS D, REGIMBEAU JM, LE TREUT YP, et al. Incidental gallbladder cancer by the AFC-GBC-2009 study group[J]. World J Surg, 2011, 35( 8): 1887- 1897. DOI: 10.1007/s00268-011-1134-3.
[7]	VEGA EA, SANHUEZA M, VIÑUELA E. Minimally invasive surgery for gallbladder cancer[J]. Surg Oncol Clin N Am, 2019, 28( 2): 243- 253. DOI: 10.1016/j.soc.2018.11.001.
[8]	GENG ZM, LEI JJ, ZHANG D, et al. Current status and controversies of minimally invasive surgery for gallbladder cancer[J]. J Southwest Med Univ, 2024, 47( 2): 93- 97. DOI: 10.3969/j.issn.2096-3351.2024.02.001. 耿智敏, 雷建军, 张东, 等. 胆囊癌微创手术治疗的现状与争议[J]. 西南医科大学学报, 2024, 47( 2): 93- 97. DOI: 10.3969/j.issn.2096-3351.2024.02.001.
[9]	POUDEL R, SHAH A. Incidence of incidental gall bladder cancer and role of routine histopathological examination in cholecystectomies specimens for benign disease[J]. J Nepal Health Res Counc, 2020, 18( 3): 547- 550. DOI: 10.33314/jnhrc.v18i3.1974.
[10]	YIN XY. Managements for the incidental gallbladder carcinoma during or after cholecystectomy[J]. Chin J Pract Surg, 2015, 35( 9): 942- 945. DOI: 10.7504/CJPS.ISSN1005-2208.2015.09.09. 殷晓煜. 胆囊切除术中及术后意外胆囊癌的处理[J]. 中国实用外科杂志, 2015, 35( 9): 942- 945. DOI: 10.7504/CJPS.ISSN1005-2208.2015.09.09.
[11]	LEE SE, KIM KS, KIM WB, et al. Practical guidelines for the surgical treatment of gallbladder cancer[J]. J Korean Med Sci, 2014, 29( 10): 1333- 1340. DOI: 10.3346/jkms.2014.29.10.1333.
[12]	Branch of Biliary Surgery, Chinese Surgical Society; Chinese Committee of Biliary Surgeons. Guideline for the diagnosis and treatment of gallbladder carcinoma(2019 edition)[J]. Chin J Surg, 2020, 58( 4): 243- 251. DOI: 10.3760/cma.j.cn112139-20200106-00014. 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专业委员会. 胆囊癌诊断和治疗指南(2019版)[J]. 中华外科杂志, 2020, 58( 4): 243- 251. DOI: 10.3760/cma.j.cn112139-20200106-00014.
[13]	WANG HJ, ZHANG BH, GU ML, et al. Prevention and surgical treatment of unexpected gallbladder carcinoma[J]. J Hepatopancreatobiliary Surg, 2021, 33( 4): 197- 199, 204. DOI: 10.11952/j.issn.1007-1954.2021.04.002. 王恒杰, 张宝华, 顾卯林, 等. 意外胆囊癌的防范和外科治疗[J]. 肝胆胰外科杂志, 2021, 33( 4): 197- 199, 204. DOI: 10.11952/j.issn.1007-1954.2021.04.002.
[14]	YIN XY. Applications and values of combined excision of extra-hepatic bile duct in curative resection of gallbladder carcinoma[J]. Chin J Pract Surg, 2016, 36( 10): 1048- 1050. DOI: 10.7504/CJPS.ISSN1005-2208.2016.10.08. 殷晓煜. 肝外胆管切除在胆囊癌根治性切除术中的应用与价值[J]. 中国实用外科杂志, 2016, 36( 10): 1048- 1050. DOI: 10.7504/CJPS.ISSN1005-2208.2016.10.08.
[15]	KIM HS, PARK JW, KIM H, et al. Optimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study[J]. J Hepatobiliary Pancreat Sci, 2018, 25( 12): 533- 543. DOI: 10.1002/jhbp.593.
[16]	WAKAI T, SHIRAI Y, YOKOYAMA N, et al. Early gallbladder carcinoma does not warrant radical resection[J]. Br J Surg, 2001, 88( 5): 675- 678. DOI: 10.1046/j.1365-2168.2001.01749.x.
[17]	OUCHI K, MIKUNI J, KAKUGAWA Y, et al. Laparoscopic cholecystectomy for gallbladder carcinoma: Results of a Japanese survey of 498 patients[J]. J Hepatobiliary Pancreat Surg, 2002, 9( 2): 256- 260. DOI: 10.1007/s005340200028.
[18]	GOETZE TO, PAOLUCCI V. Immediate re-resection of T1 incidental gallbladder carcinomas: A survival analysis of the German registry[J]. Surg Endosc, 2008, 22( 11): 2462- 2465. DOI: 10.1007/s00464-008-9747-9.
[19]	MATSUYAMA R, MATSUO K, MORI R, et al. Incidental gallbladder cancer on cholecystectomy: Strategy for re-resection of presumed benign diseases from a retrospective multicenter study by the Yokohama clinical oncology group[J]. In Vivo, 2021, 35( 2): 1217- 1225. DOI: 10.21873/invivo.12372.
[20]	GOEL M, PANDROWALA S, PATEL P, et al. Node positivity in T1b gallbladder cancer: A high volume centre experience[J]. Eur J Surg Oncol, 2022, 48( 7): 1585- 1589. DOI: 10.1016/j.ejso.2022.03.013.
[21]	CHO JK, LEE W, JANG JY, et al. Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: A retrospective study[J]. World J Surg Oncol, 2019, 17( 1): 8. DOI: 10.1186/s12957-018-1556-6.
[22]	LEE W, JEONG CY, JANG JY, et al. Do hepatic-sided tumors require more extensive resection than peritoneal-sided tumors in patients with T2 gallbladder cancer? Results of a retrospective multicenter study[J]. Surgery, 2017, 162( 3): 515- 524. DOI: 10.1016/j.surg.2017.05.004.
[23]	LIU CM, DONG JM, CHAI YJ, et al. Advances and reflections on surgical treatment of gallbladder cancer[J]. Zhejiang Med J, 2023, 45( 3): 332- 336. DOI: 10.12056/j.issn.1006-2785.2023.45.3.2022-2736. 刘晨鸣, 董家铭, 柴应杰, 等. 胆囊癌外科治疗的进展和思考[J]. 浙江医学, 2023, 45( 3): 332- 336. DOI: 10.12056/j.issn.1006-2785.2023.45.3.2022-2736.
[24]	SONG TQ. Progress in surgical treatment of gallbladder cancer[J]. J Hepatobiliary Surg, 2020, 28( 6): 407- 411. DOI: 10.3969/j.issn.1006-4761.2020.06.004. 宋天强. 胆囊癌外科治疗进展[J]. 肝胆外科杂志, 2020, 28( 6): 407- 411. DOI: 10.3969/j.issn.1006-4761.2020.06.004.
[25]	YUZA K, SAKATA J, PRASOON P, et al. Long-term outcomes of surgical resection for T1b gallbladder cancer: An institutional evaluation[J]. BMC Cancer, 2020, 20( 1): 20. DOI: 10.1186/s12885-019-6507-2.
[26]	XU L, TAN HD, LIU XL, et al. Survival benefits of simple versus extended cholecystectomy and lymphadenectomy for patients with T1b gallbladder cancer: An analysis of the surveillance, epidemiology, and end results database(2004 to 2013)[J]. Cancer Med, 2020, 9( 11): 3668- 3679. DOI: 10.1002/cam4.2989.
[27]	BENSON AB, D’ANGELICA MI, ABBOTT DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19( 5): 541- 565. DOI: 10.6004/jnccn.2021.0022.
[28]	CHIBA N, SHIMAZU M, OCHIAI S, et al. Resection of hepatic lesions perfused by the cholecystic vein using indocyanine green navigation in patients with cT2 gallbladder cancer[J]. World J Surg, 2019, 43( 2): 608- 614. DOI: 10.1007/s00268-018-4810-8.
[29]	JIANG XQ, HU MT, WANG JH. Application value and controversy of extended radical surgery for gallbladder cancer[J]. Chin J Pract Surg, 2023, 43( 11): 1233- 1237. DOI: 10.19538/j.cjps.issn1005-2208.2023.11.07. 姜小清, 胡明泰, 王敬晗. 胆囊癌行扩大根治术的应用价值及争议[J]. 中国实用外科杂志, 2023, 43( 11): 1233- 1237. DOI: 10.19538/j.cjps.issn1005-2208.2023.11.07.
[30]	D’ANGELICA M, DALAL KM, DEMATTEO RP, et al. Analysis of the extent of resection for adenocarcinoma of the gallbladder[J]. Ann Surg Oncol, 2009, 16( 4): 806- 816. DOI: 10.1245/s10434-008-0189-3.
[31]	REDDY SK, MARROQUIN CE, KUO PC, et al. Extended hepatic resection for gallbladder cancer[J]. Am J Surg, 2007, 194( 3): 355- 361. DOI: 10.1016/j.amjsurg.2007.02.013.
[32]	ALOIA TA, JÁRUFE N, JAVLE M, et al. Gallbladder cancer: Expert consensus statement[J]. HPB(Oxford), 2015, 17( 8): 681- 690. DOI: 10.1111/hpb.12444.
[33]	NIGRI G, BERARDI G, MATTANA C, et al. Routine extra-hepatic bile duct resection in gallbladder cancer patients without bile duct infiltration: A systematic review[J]. Surgeon, 2016, 14( 6): 337- 344. DOI: 10.1016/j.surge.2016.06.004.
[34]	MIZUNO T, EBATA T, YOKOYAMA Y, et al. Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer[J]. Br J Surg, 2019, 106( 5): 626- 635. DOI: 10.1002/bjs.11088.
[35]	FERNANDES EDE S, MELLO FT, RIBEIRO-FILHO J, et al. The largest western experience with hepatopancreatoduodenectomy: Lessons learned with 35 cases[J]. Arq Bras Cir Dig, 2016, 29( 1): 17- 20. DOI: 10.1590/0102-6720201600010005.
[36]	D’ANGELICA M, MARTIN RC 2, JARNAGIN WR, et al. Major hepatectomy with simultaneous pancreatectomy for advanced hepatobiliary cancer[J]. J Am Coll Surg, 2004, 198( 4): 570- 576. DOI: 10.1016/j.jamcollsurg.2003.11.022.
[37]	BERGER-RICHARDSON D, CHESNEY TR, ENGLESAKIS M, et al. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review[J]. Surgery, 2017, 161( 3): 618- 627. DOI: 10.1016/j.surg.2016.08.007.
[38]	LUNDBERG O, KRISTOFFERSSON A. Wound recurrence from gallbladder cancer after open cholecystectomy[J]. Surgery, 2000, 127( 3): 296- 300. DOI: 10.1067/msy.2000.104487.
[39]	ZHAO X, LI XY, JI W. Laparoscopic versus open treatment of gallbladder cancer: A systematic review and meta-analysis[J]. J Minim Access Surg, 2018, 14( 3): 185- 191. DOI: 10.4103/jmas.JMAS_223_16.
[40]	CHEE MYM, WU AGR, FONG KY, et al. Robotic, laparoscopic and open surgery for gallbladder cancer: A systematic review and network meta-analysis[J]. Surg Endosc, 2024, 38( 9): 4846- 4857. DOI: 10.1007/s00464-024-11162-6.
[41]	AHMED SH, USMANI SUR, MUSHTAQ R, et al. Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review& meta-analysis[J]. Am J Surg, 2023, 225( 6): 975- 987. DOI: 10.1016/j.amjsurg.2023.01.008.
[42]	VEGA EA, DE ARETXABALA X, QIAO W, et al. Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer[J]. Br J Surg, 2020, 107( 3): 289- 300. DOI: 10.1002/bjs.11379.
[43]	ZHANG CW. Application of minimally invasive surgery in radical resection of gallbladder cancer[J]. Zhejiang Med J, 2023, 45( 18): 1905- 1909, 1920. DOI: 10.12056/j.issn.1006-2785.2023.45.18.2023-1453. 张成武. 微创手术在胆囊癌根治性切除术中的应用[J]. 浙江医学, 2023, 45( 18): 1905- 1909, 1920. DOI: 10.12056/j.issn.1006-2785.2023.45.18.2023-1453.
[44]	WANG J, LI Z, CHEN LL, et al. Comparing robotic and open surgical techniques in gallbladder cancer management: A detailed systematic review and meta-analysis[J]. J Robot Surg, 2024, 18( 1): 111. DOI: 10.1007/s11701-024-01851-8.