Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma
Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma
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DOI：
10.1002/bjs.8950
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发表时间：
2013-01-01
影响因子：
9.6
通讯作者：
Gigot, J. F.
中科院分区：
文献类型：
--
作者：
Farges, O.;Regimbeau, J. M.;Gigot, J. F.
背景：肝门部恶性肿瘤手术前胆管引流(PBD)的适应证仍有争议。这项研究的目的是调查目前欧洲关于Klatkin肿瘤肝切除术前胆汁引流的做法。方法：回顾分析了1997-2008年间在11家欧洲教学医院接受肝门部胆管癌行正规或扩大右或左肝切除术的所有患者，这些患者入院时和手术时的血清胆红素水平均有详细资料。PBD是由医生自行决定的。主要结果是90天的死亡率。次要结果是发病率和死亡原因。通过Logistic回归分析，在整个人群中以及在右侧和左侧肝切除组中，分别评估PBD和术前血清胆红素水平与术后死亡率的关系，并调整混杂因素。结果：共有366例患者入选，其中180例患者接受了PBD。总死亡率为10.7%，右侧肝切除术后死亡率高于左侧(14.7%比6.6%；调整优势比(OR)3.16，95%可信区间1.5~6.65；P=0.001)。PBD不影响术后总死亡率，但与右肝切除术后死亡率降低(调整后OR0.29，0.11至0.77；P=0.013)和左肝切除后死亡率增加(调整后OR4.06，1.01至16.30；P=0.035)相关。术前血清胆红素水平>50mU/L也与死亡率增加相关，但仅在右肝切除术后(调整OR7.02，1.73%至28.52%；P=0.002)。结论：肝门部胆管癌伴黄褐斑患者的总死亡率不受PBD的影响，但行右侧和左侧肝切除术的患者之间可能存在差异。版权所有(C)2012英国外科学会杂志有限公司。由John Wiley&Sons，Ltd.出版。
Background: Indications for preoperative biliary drainage (PBD) in the context of hepatectomy for hilar malignancies are still debated. The aim of this study was to investigate current European practice regarding biliary drainage before hepatectomy for Klatskin tumours. Methods: This was a retrospective analysis of all patients who underwent formal or extended right or left hepatectomy for hilar cholangiocarcinoma between 1997 and 2008 at 11 European teaching hospitals, and for whom details of serum bilirubin levels at admission and at the time of surgery were available. PBD was performed at the physicians' discretion. The primary outcome was 90-day mortality. Secondary outcomes were morbidity and cause of death. The association of PBD and of preoperative serum bilirubin levels with postoperative mortality was assessed by logistic regression, in the entire population as well as separately in the right- and left-sided hepatectomy groups, and was adjusted for confounding factors. Results: A total of 366 patients were enrolled; PBD was performed in 180 patients. The overall mortality rate was 10.7 per cent and was higher after right- than left-sided hepatectomy (14.7 versus 6.6 per cent; adjusted odds ratio (OR) 3.16, 95 per cent confidence interval 1.50 to 6.65; P = 0.001). PBD did not affect overall postoperative mortality, but was associated with a decreased mortality rate after right hepatectomy (adjusted OR 0.29, 0.11 to 0.77; P = 0.013) and an increased mortality rate after left hepatectomy (adjusted OR 4.06, 1.01 to 16.30; P = 0.035). A preoperative serum bilirubin level greater than 50 mu mol/l was also associated with increased mortality, but only after right hepatectomy (adjusted OR 7.02, 1.73 to 28.52; P = 0.002). Conclusion: PBD does not affect overall mortality in jaundiced patients with hilar cholangiocarcinoma, but there may be a difference between patients undergoing right-sided versus left-sided hepatectomy. Copyright (C) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.