|
ウエムラ シユウイチロウ
Uemura Shiyuuichirou
植村 修一郎 所属 医学部 医学科（東京女子医科大学病院） 職種 助教 |
|
| 論文種別 | 原著 |
| 言語種別 | 英語 |
| 査読の有無 | 査読なし |
| 表題 | Resectional surgery in gallbladder cancer with jaundice-how to improve the outcome? |
| 掲載誌名 | 正式名：Langenbeck's archives of surgery 略 称：Langenbecks Arch Surg ISSNコード：14352451/14352443 |
| 掲載区分 | 国外 |
| 巻・号・頁 | 406(3),pp.791-800 |
| 著者・共著者 | Rahul K Chaudhary, HIGUCHI Ryota, YAZAWA Takehisa, UEMURA Shuichiro, IZUMO Wataru, MATSUNAGA Yutaro, NAGANO Erika, SATO Yasuto, OTA Takeshi, FURUKAWA Toru, YAMAMOTO Masakazu |
| 発行年月 | 2021/05 |
| 概要 | PURPOSE:To evaluate the surgical outcomes of patients with gallbladder cancer (GBC) with jaundice due to as-yet unelucidated prognostic factors.METHODS:A total of 348 GBC patients underwent resection at our institute between 1985 and 2016. Of these, 67 had jaundice (serum total bilirubin ≥ 2 mg/dL). Preoperative biliary drainage was performed, with portal vein embolization as required. All patients underwent radical surgery. We retrospectively evaluated the outcomes, performed multivariate analysis for overall survival, and compared our findings to those reported in the literature.RESULTS:The 5-year survival rate of M0 (no distant metastasis) GBC patients with jaundice, who underwent resectional surgery, was 21.9%, versus 68.3% in those without jaundice (p < 0.05). Since 2000, surgical mortality in GBC patients with jaundice has decreased from 12 to 6.8%. Patients with jaundice had more advanced disease and underwent major hepatectomies and vascular resections; however, preoperative jaundice alone was not a prognostic factor. Multivariate analysis of jaundiced patients revealed that percutaneous biliary drainage (PTBD) (vis-à-vis endoscopic drainage [EBD], hazard ratio [HR] 2.82), postoperative morbidity (Clavien-Dindo classification ≥ 3, HR 2.31), and distant metastasis (HR 1.85) were predictors of poor long-term survival. The 5-year survival and peritoneal recurrence rates in M0 patients with jaundice were 16% and 44%, respectively, for patients with PTBD and 39% (p < 0.05) and 13% (p = 0.07) for those with EBD.CONCLUSION:M0 GBC patients with jaundice should undergo surgery if R0 resection is possible. Preoperative EBD may be superior to PTBD in M0 GBC patients with jaundice, although further studies are needed. |
| DOI | 10.1007/s00423-020-02075-8 |
| PMID | 33619629 |