Combined vascular resection in operative resection for hilar cholangiocarcinoma: Does it work or not?
Combined vascular resection in operative resection for hilar cholangiocarcinoma: Does it work or not?
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DOI：
10.1016/j.surg.2006.09.016
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发表时间：
2007-05-01
期刊：
影响因子：
3.8
通讯作者：
Nozawa, Satoshi
中科院分区：
文献类型：
--
作者：
Miyazaki, Masaru;Kato, Atsushi;Nozawa, Satoshi
背景目前尚不清楚联合血管切除术如何影响肝门部胆管癌患者的预后。我们的目的是通过分析所有接受手术切除的患者的结果来评估联合血管切除术在肝门部胆管癌患者中的意义。228例连续肝门部胆管癌患者中，共有161例接受了胆管切除术，包括各种类型的肝切除术（88%）和胰切除术（4%）。43例行联合血管切除术。单纯门静脉切除34例，门静脉和肝动脉联合切除7例，单纯肝右动脉切除2例。比较单纯门静脉切除组（34例）、肝动脉切除组（9例）和非血管性切除组（118例）的疗效。在44例接受联合门静脉切除术的患者中，80%的患者存在组织学阳性的肿瘤侵犯门静脉外膜。11例（7%）患者发生手术死亡。非血管切除组的生存率优于单纯门静脉切除组和肝动脉切除组：根治性切除后1、3和5年分别为72%、52%和41%对47%、31%和25%（P <0.05）和17%、0%和0%（P <0.0001）。多因素分析显示影响术后生存率的4个独立预后因素：手术可治愈性、淋巴结转移、门静脉切除和肝动脉切除。虽然门静脉和肝动脉切除都是局部晚期肝门部胆管癌根治性手术切除后的独立预后不良因素，但从手术风险的角度来看，门静脉切除是可以接受的，并可能改善所选患者的预后，但联合肝动脉切除并不合理。
Background. It is still not clear how combined vascular resection affects the outcome of patients with hilar cholangiocarcinoma. Our aim was to evaluate implications of combined vascular resection in patients with hilar cholangiocarcinoma by analyzing the outcomes of all patients who underwent operative resection.Methods. A total of 161 of 228 consecutive Patients with hilar cholangiocarcinoma underwent bile duct resection with various types of hepatectomy (88%) and pancreaticoduodenectomy (4%). Combined vascular resection was carried out in 43 Patients. Thirty four patients had portal vein resection alone, 7 patients had both portal vein and hepatic artery resection, and 2 Patients had right hepatic artery resection only. The outcomes were compared between the 3 groups: the portal vein resection alone (34), hepatic artery resection (9), and non-vascular resection (118).Results. Histologically-positive tumor invasion to the portal vein beyond the adventitia was present in 80% of 44 patients undergoing combined portal vein resection. Operative mortality occurred in 11 (7%) patients. The survival rates of the non-vascular resection group were better than that of the portal vein resection alone and the hepatic artery resection groups: 1, 3, and 5 years after curative resection, 72%, 52%, and 41% versus 4 7%, 31%, and 25% (P < .05), and 17%, 0%, and 0% (P < .0001), respectively. Multivariate analysis showed 4 independent prognostic factors of adverse effect on survival after operation; operative curability, lymph node metastases, portal vein resection, and hepatic artery resection.Conclusions. Although both portal vein and hepatic artery resection are independent poor prognostic factors after curative operative resection of locally advanced hilar cholangiocarcinoma, portal vein resection is acceptable from an operative risk perspective and might improve the prognosis in the selected patients, however, combined hepatic artery resection can not be justified.