Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion
Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion
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DOI：
10.1007/s11605-018-3948-x
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发表时间：
2019-07-01
影响因子：
3.2
通讯作者：
Yamamoto, Masakazu
中科院分区：
文献类型：
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作者：
Higuchi, Ryota;Yazawa, Takehisa;Yamamoto, Masakazu
目的探讨肝门部胆管癌伴血管侵犯患者的近期和远期疗效。方法对2000~2016年间249例肝门部胆管癌术后患者的临床资料进行回顾性分析。患者评估包括血管切除后的短期手术结果和组织病理学血管侵犯的长期结果。结果死亡率为3.6%，肝动脉切除为16%，门静脉切除为5.4%，无血管切除为1.7%(p=0.029)。两组间Clavien-Dindo 3级并发症的发生率无差异。与围手术期病死率相关的因素有肝动脉切除(OR[OR]=25.5)、右半切(OR=13.0)、中央二切(OR=13.8)。对总生存期进行多因素分析发现：癌胚抗原水平5 ng/mL(风险比[HR]=1.68)、低分化(HR=2.39)、远处转移(HR=1.97)和R1侵袭性切除(HR=2.13)是影响预后的几个因素。门静脉侵犯和M0R0/1Cis患者的5年生存率为35.6%，明显低于无门静脉侵犯和M0R/1Cis患者的53.4%，但好于门静脉侵犯和M1或R1患者的0%。有肝动脉侵犯和M0R0/1cis者占24.7%，明显低于无肝动脉侵犯者和M0R0/1cis者的53.4%，但明显好于有肝动脉侵犯者和M1或R1者的0%。结论肝门周围胆管癌行血管切除者近期预后较差。R0M0病的长期存活率更有利；建议进行积极的手术。
PurposeTo investigate short- and long-term surgical outcomes for patients with perihilar cholangiocarcinoma and vascular invasion.MethodsData from 249 patients who underwent perihilar cholangiocarcinoma surgery between 2000 and 2016 were retrospectively analyzed. Patient evaluations included short-term surgical outcomes following vascular resection and long-term outcomes in cases with histopathological vascular invasion.ResultsMortality was 3.6% overall; 16% for hepatic artery resections, 5.4% for portal vein resections, and 1.7% in the absence of vascular resection (p=0.029). No between-group differences were observed in the incidence of Clavien-Dindo grade 3 complications. The factors related to perioperative mortality were hepatic artery resection (odds ratio [OR]=25.5), right trisectionectomy (OR=13.0), and central bisectionectomy (OR=13.8). Multivariate analysis for overall survival identified several prognostic factors: carcinoembryonic antigen level 5ng/mL (hazard ratio [HR]=1.68), poor differentiation (HR=2.39), distant metastasis (HR=1.97), and R1 invasive resection (HR=2.13). Five-year overall survival for patients with portal vein invasion and M0R0/1cis was 35.6%, significantly worse than the 53.4% for patients with no portal vein invasion and M0R/1cis but better than the 0% for patients with portal vein invasion and M1 or R1. Those with hepatic arterial invasion and M0R0/1cis were 24.7%, significantly worse than the 53.4% for patients with no hepatic arterial invasion and M0R0/1cis but significantly better than the 0% for patients with hepatic arterial invasion and M1 or R1.ConclusionShort-term outcomes for patients with perihilar cholangiocarcinoma and undergoing vascular resection were poor compared to those without vascular resection. Long-term survival in R0M0 disease was more favorable; aggressive surgery is recommended.