Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality
Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality
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DOI：
10.1007/s00534-009-0208-1
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发表时间：
2010-07-01
影响因子：
3
通讯作者：
Kawasaki, Ryosuke
中科院分区：
文献类型：
--
作者：
Hirano, Satoshi;Kondo, Satoshi;Kawasaki, Ryosuke
肝门部胆管癌的根治性切除术仍然与显著的发病率和死亡率相关。本研究的目的是分析短期的手术结果，并验证我们的策略，包括术前管理和选择的手术programmes.We手术治疗146例肝门部胆管癌的管理策略包括术前胆道引流，门静脉栓塞，并选择基于肿瘤的扩展和肝脏储备的手术程序。126例行肝大部切除，20例行肝尾叶或肝门部胆管切除，5年生存率为35.5%，住院死亡率为3.4%，并发症发生率为44%。高胆红素血症（总胆红素> 5 mg/dL，术后持续时间> 7天）和肝脓肿是最常见的并发症。9例肝功能衰竭（总胆红素> 10 mg/dL）患者中有5例发生院内死亡。5例死亡患者中有4例因其他并发症而发生残肝循环障碍。多因素分析显示，手术时间是术后并发症的独立预测因素（OR = 1.005，95%可信区间为1.000-1.010，P = 0.04），肝门部胆管癌的侵袭性切除，严格的管理策略，可获得较低的死亡率。手术时间延长是肝胆切除术后发病的风险。
Radical resection for hilar cholangiocarcinoma is still associated with significant morbidity and mortality. The aim of this study was to analyze short-term surgical outcomes and to validate our strategies, including preoperative management and selection of operative procedure.We surgically treated 146 consecutive patients with hilar cholangiocarcinoma with a management strategy consisting of preoperative biliary drainage, portal vein embolization, and selection of operative procedure based on tumor extension and hepatic reserve. Major hepatectomy was conducted in 126 patients, and caudate lobectomy or hilar bile duct resection in 20 patients.The overall 5-year survival rate was 35.5%, with overall in-hospital mortality and morbidity rates of 3.4 and 44%, respectively. Hyperbilirubinemia (total bilirubin > 5 mg/dL, persisted for > 7 postoperative days) and liver abscess were the most frequent complications. Five among 9 patients with liver failure (total bilirubin > 10 mg/dL) encountered in-hospital mortality. Four out of 5 mortality patients had suffered circulatory impairment of the remnant liver due to other complications. Multivariate analysis revealed that operative time is a single independent significant predictive factor (odds ratio, 1.005; 95% confidence interval, 1.000-1.010, P = 0.04) for postoperative complications.Aggressive resection for hilar cholangiocarcinoma, performed in accordance with strict management strategy, achieved acceptably low mortality. Prolonged operative time was a risk for morbidity following hepatobiliary resection.