Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC) -: When is it worthwhile?: Single center experience with 27 resections in 50 patients over a 5-year period
Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC) -: When is it worthwhile?: Single center experience with 27 resections in 50 patients over a 5-year period
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DOI：
10.1097/01.sla.0000149426.08580.a1
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发表时间：
2005-01-01
影响因子：
9
通讯作者：
Broelsch, CE
中科院分区：
文献类型：
--
作者：
Lang, H;Sotiropoulos, GC;Broelsch, CE
目的：目的：探讨扩大肝切除术在局部晚期肝内胆管细胞癌（ICC）中的作用。背景资料：ICC是一种罕见的肿瘤，必须与肝细胞癌和肝外胆管癌明确区分。据认为，长期生存只能通过手术切除。方法：1998年4月至2003年3月，50例局部晚期ICC（肿瘤累及4个以上的肝段）进行了手术探查。数据进行了分析，患者的特点，术中细节，病理结果，并衡量肿瘤复发，治疗复发，survival.Results：切除率为27 50（54%）。扩大右半肝切除19例，扩大左肝切除8例。16例患者行肝门分叉部切除术12例，膈部分切除术6例，腔静脉部分切除术4例，肝左静脉切除再植术1例，门静脉切除术5例，肝右动脉切除重建术1例。16例患者实现了肿瘤完全切除（R 0切除）。在11例病例中，切缘有显微肿瘤（R1-切除）。切除后，总的1年和3年生存率分别为69%和55%。R1切除术和剖腹探查术后，中位生存期分别为5个月和7个月。R 0切除后，计算的中位生存期和1年及3年生存率分别为46个月、94%和82%（P = 0.0039;对数秩检验）。16例中6例肿瘤复发，2例分别于术后28个月和46个月因复发死亡。结论：R 0切除术可延长患者的生存期，即使是晚期ICC患者。特别是在没有血管侵犯的孤立性肿瘤（UICC 1期，第六分类）中，长期生存和治愈的机会很大。R1切除术后的不良结果和高手术发病率并不能证明姑息性切除是合理的，但强调需要改善术前可切除性评估，以及积极的术中方法，以实现肿瘤的完全切除。
Objective: To evaluate the role of extended hepatectomy in locally advanced intrahepatic cholangiocarcinoma (ICC).Summary Background Data: ICC is a rare tumor which has to be clearly distinguished from hepatocellular carcinoma and extrahepatic bile duct carcinoma. It is believed that long-term survival can only be achieved by surgical resection.Methods: Between April 1998 and March 2003, 50 patients with locally advanced ICC (tumor involvement of more than 4 liver segments) underwent surgical exploration. Data were analyzed with regard to patients' characteristics, intraoperative details, pathologic findings, and outcome measured by tumor recurrence, treatment of recurrence, and survival.Results: Resectability rate was 27 of 50 (54%). There were 19 extended right and 8 extended left hepatectomies. In addition, in 16 patients the following 29 procedures were performed: resection of hilar bifurcation (n = 12), partial resection of diaphragm (n = 6), partial resection of vena cava (n = 4), resection and reinsertion of left liver vein (n = 1), portal vein resection (n = 5), resection and reconstruction of right hepatic artery (n = 1). Complete tumor removal (R0-resection) was achieved in 16 patients. In 11 cases, there was microscopic tumor at the cutting margin (R1-resection). Following resection, the overall 1- and 3-year-survival rates were 69% and 55%. After R1-resection and explorative laparotomy, median survival was 5 and 7 months, respectively. Following R0-resection, the calculated median survival and 1- and 3-year-survival rates are 46 months, 94% and 82% (P = 0.0039; log-rank test). Tumor recurred in 6 of 16 patients, and so far 2 patients died of recurrence 28 and 46 months after operation.Conclusions: R0-resection can provide prolonged survival, even in patients with advanced ICC. In particular in solitary tumors without vascular invasion (UICC stage 1, sixth classification) there is a major chance for long-term survival and cure. The poor results after R1-resection and the high operative morbidity do not justify palliative resections but underline the need for an improved preoperative assessment of resectability, as well as an aggressive intraoperative approach, to achieve complete tumor resection.