イズモ　ワタル   IZUMO Wataru   出雲　渉    所属   医学部 医学科（東京女子医科大学病院）    職種   非常勤講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Surgery in node-positive gallbladder cancer: The implication of an involved superior retro-pancreatic lymph node.
掲載誌名	正式名：Surgery 略　 称：Surgery ISSNコード：15327361/00396060
巻・号・頁	165(3),pp.541-547
著者・共著者	Chaudhary Rahul K, Higuchi Ryota, Yazawa Takehisa, Uemura Shuichiro, Izumo Wataru, Furukawa Toru, Kiyohara Kosuke, Yamamoto Masakazu
発行年月	2019/03
概要	BACKGROUND:The treatment approach to node-positive gallbladder cancer has unresolved issues with regard to the management of patients with a positive superior retro-pancreatic (level 13a) node, which is the highest level of spread. The American Joint Committee on Cancer remains unclear on the status of the 13a node.METHODS:This retrospective study consisted of 165 patients with node-positive gallbladder cancer without distant metastasis. Patients were reclassified according to the American Joint Committee on Cancer eighth edition classification. The survival of patients with positive level 13a node was compared with that of patients with N1 disease (T stage-wise) and those with para-aortic nodal disease. A multivariate analysis was performed for factors affecting survival.RESULTS:The 5-year survival of patients with positive level 13a with 1-3 nodes was similar to those with N1 disease (40.2% and 32.9%, respectively) and was better than those with more distant nodal spread (P < .05). In univariate and multivariate analyses, intraoperative blood loss (hazard ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients.CONCLUSION:A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and should be treated as such.
DOI	10.1016/j.surg.2018.09.003
PMID	30348459