@article{oai:niigata-u.repo.nii.ac.jp:00008991, author = {若井, 俊文}, issue = {4}, journal = {新潟医学会雑誌, 新潟医学会雑誌}, month = {Apr}, note = {Two-thirds of early gallbladder carcinomas are classified as superficial macroscopic type. Most pathologic T1b (pT1b) gallbladder carcinomas spread only locally. As lymph-vascular invasion and nodal metastasis are rarely found in pT1 tumor, postoperative diagnosis of early gallbladder carcinoma does not warrant additional radical resection when surgical margin is cancer-free. No nodal disease or a single positive node indicates a favorable outcome after resection, whereas radical lymph node dissection is effective for selected patients with multiple positive nodes, provided that an R0 resection is feasible. Direct liver invasion and portal tract invasion are the main modes of hepatic spread from resectable gallbladder carcinoma. Portal tract invasion mainly results from lymphatic spread within the portal tracts. The mode of hepatic spread and residual tumor status, rather than the type of hepatectomy, is the most important predictor of survival after resection for gallbladder carcinoma with hepatic involvement. The correlation between gross depth of direct liver invasion and distance of portal tract invasion may be useful clinically for estimating adequate hepatectomy margins, since partial hepatectomy involving the gallbladder bed is a critical part of the resection for gallbladder carcinoma.}, pages = {151--156}, title = {胆嚢癌に対する外科治療}, volume = {128}, year = {2014} }