T2 담낭암이 의심되는 경우의 수술적 치료: 최소침습적 수술

Abstract

There is controversy regarding surgical treatment of gallbladder carcinomas. Generally, simplecholecystectomy alone (including laparoscopic cholecystectomy) is an adequate treatment forpathologic stage T1a gallbladder carcinoma. T1b tumors are associated with good long-termsurvival even after simple cholecystectomy, but are associated with a slightly elevatedlocoregional recurrence rate. Therefore, a definitive curative treatment with liver resection andlymph node dissection should be performed.According to anecdotal experiences at our institution, simple, minimally invasive, laparoscopiccholecystectomy in certain patients (T1a) is likely to provide an acceptable surgical outcomecompared to radical surgery in treating gallbladder carcinoma. And as evidence for minimallyinvasive surgical treatment for gallbladder carcinoma with T1b and T2 gallbladder carcinomashas increased and technical improvements have occurred in laparoscopic lymph nodedissection, we have extended the indication of minimally invasive laparoscopic surgery(including da Vinci Robotic surgery) to T2 gallbladder carcinoma.Even though we cannot draw firm conclusions because the sample size was small and studyduration was short, preliminary results are intriguing.a) Among 15 patients with T1a gallbladder carcinomas who were treated with minimallyinvasive surgery, there has been no recurrence to date. b) Among 7 patients with T1b lesions,one patient had liver metastasis 2 years after surgery. c) Among 15 patients with T2 lesions, twopatients had disease recurrence in the para-aortic lymph node area 1 and 5 months,respectively, after surgery (laparoscopic simple cholecystectomy). d) After doing regional lymphnode dissection (sometimes aortocaval lymph nodes as well) in 2006, 2 of 10 patients (20%)had positive regional lymph nodes after surgery but no recurrence has occurred to date.For suspected T1 and T2 gallbladder carcinomas without regional and systemic metastasis,after a preoperative study (using EUS and PET) for the main lesion and metastasis, we foundthat we can treat them with minimally invasive laparoscopic (or da Vinci Robotic)cholecystectomy and lymph node dissection (if needed, including aortocaval para-aortic lymphnodes).