The impact of portal vein resection on outcomes for hilar cholangiocarcinoma
The impact of portal vein resection on outcomes for hilar cholangiocarcinoma
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门静脉切除术对肝门部胆管癌治疗效果的影响
DOI：
10.1002/cncr.27492
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发表时间：
2012-10-01
期刊：
影响因子：
6.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
de Jong, Mechteld C.;Marques, Hugo;Pawlik, Timothy M.
背景肝门部胆管癌的手术策略通常包括肝切除术，但门静脉切除术（PVR）的作用仍然存在争议。在这项研究中，作者试图确定与肝门部胆管癌手术治疗后结局相关的因素，并检查PVR对生存率的影响。方法：从一个国际多机构数据库中确定了1984年至2010年期间接受治疗性手术治疗肝门部胆管癌的305例患者。采用单变量和多变量分析评价临床病理学数据。结果：大多数患者患有肝门部胆管癌，肿瘤分类为T3/T4（51.1%）和Bismuth-Corlette II/III型（60.9%）。单纯肝外胆管切除术（EHBR）（26.6%）;或肝切除术和EHBR不伴PVR（56.7%）;或肝切除术、EHBR和PVR联合（16.7%）。行肝切除联合EHBR的患者（无PVR，64.2%;有PVR，66.7%）的阴性切除（R 0）切缘状态高于单纯EHBR（54.3%; P <0.001）。接受肝切除术联合EHBR的患者（无PVR，6个淋巴结;有PVR，4个淋巴结）评估的中位淋巴结数量高于仅接受EHBR的患者（2个淋巴结; P <0.001）。单纯行EHBR患者的90天死亡率（1.2%）低于行肝切除联合EHBR的患者（无PVR，10.6%，有PVR，17.6%; P <0.001）。总体5年生存率为20.2%。与不良预后相关的因素包括淋巴结转移（风险比[HR]，1.79; P = .002）和R1切缘状态（HR，1.81; P < .001）。显微镜下血管浸润不影响生存率（HR，1.23; P = .19）。在接受肝切除联合EHBR的患者中，PVR与更差的长期结局无关（P = 0.76）。结论：单纯EHBR与更大的手术切缘阳性风险和更差的淋巴结清除率相关。目前的结果表明，肝切除术应被认为是标准的治疗肝门部胆管癌，PVR应进行必要时，以消除所有疾病。联合肝切除、EHBR和PVR可以为一些晚期肝门部胆管癌患者提供长期生存。2012年癌症。(c)2012年美国癌症协会
BACKGROUND. Surgical strategy for hilar cholangiocarcinoma often includes hepatectomy, but the role of portal vein resection (PVR) remains controversial. In this study, the authors sought to identify factors associated with outcome after surgical management of hilar cholangiocarcinoma and examined the impact of PVR on survival. METHODS: Three hundred five patients who underwent curative-intent surgery for hilar cholangiocarcinoma between 1984 and 2010 were identified from an international, multi-institutional database. Clinicopathologic data were evaluated using univariate and multivariate analyses. RESULTS: Most patients had hilar cholangiocarcinoma with tumors classified as T3/T4 (51.1%) and Bismuth-Corlette type II/III (60.9%). Resection involved extrahepatic bile duct resection (EHBR) alone (26.6%); or hepatectomy and EHBR without PVR (56.7%); or combined hepatectomy, EHBR, and PVR (16.7%). Negative resection (R0) margin status was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 64.2%; with PVR, 66.7%) versus EHBR alone (54.3%; P < .001). The median number of lymph nodes assessed was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 6 lymph nodes; with PVR, 4 lymph nodes) versus EHBR alone (2 lymph nodes; P < .001). The 90-day mortality rate was lower for patients who underwent EHBR alone (1.2%) compared with the rate for patients who underwent hepatectomy plus EHBR (without PVR, 10.6%, with PVR, 17.6%; P < .001). The overall 5-year survival rate was 20.2%. Factors that were associated with an adverse prognosis included lymph node metastasis (hazard ratio [HR], 1.79; P = .002) and R1 margin status (HR, 1.81; P < .001). Microscopic vascular invasion did not influence survival (HR, 1.23; P = .19). Among the patients who underwent hepatectomy plus EHBR, PVR was not associated with a worse long-term outcome (P = .76). CONCLUSIONS: EHBR alone was associated with a greater risk of positive surgical margins and worse lymph node clearance. The current results indicated that hepatectomy should be considered the standard treatment for hilar cholangiocarcinoma, and PVR should be undertaken when necessary to extirpate all disease. Combined hepatectomy, EHBR, and PVR can offer long-term survival in some patients with advanced hilar cholangiocarcinoma. Cancer 2012. (c) 2012 American Cancer Society.