Hepatic resection and transplantation for peripheral cholangiocarcinoma
Hepatic resection and transplantation for peripheral cholangiocarcinoma
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DOI：
10.1016/s1072-7515(01)00953-x
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发表时间：
1997-11-01
影响因子：
5.2
通讯作者：
Starzl, TE
中科院分区：
文献类型：
--
作者：
Casavilla, FA;Marsh, JW;Starzl, TE
背景资料：最近的出版物质疑原位肝移植（奥尔特）在治疗晚期或不可切除的外周胆管癌（Ch-Ca）的作用研究设计：我们回顾了我们的经验，Ch-Ca，以确定生存率，复发模式，和风险因素，在1981年和1994年之间接受肝切除术或奥尔特的54例患者。在无法切除的肿瘤患者（n = 12）和晚期肝硬化患者（n = 8）中进行了肝移植。有33名女性（61%）和21名男性（39%），平均年龄为54.3岁。中位随访时间为6.8年。结果：30天内死亡率为7.4%。术后1年患者和无瘤生存率分别为64%和57%，3年为34%和34%，5年为26%和27%。32例患者（59.3%）出现肿瘤复发。单因素分析显示，多发性肿瘤，双叶肿瘤分布，区域淋巴结受累，转移的存在，阳性手术切缘，和先进的pTNM分期是无肿瘤和患者生存的显着负预测因子。多因素分析显示，切缘阳性、多发肿瘤和淋巴结转移与预后不良独立相关。当这三个阴性预测因素的患者被排除在外，患者生存率在1，3，5年分别为74%，64%，和62%.Conclusions：肝切除术和奥尔特是有效的治疗Ch-Ca时，肿瘤可以被删除与足够的利润率，病变是单一的，淋巴结不涉及。(C)1997年由美国外科医生学会出版）。
Background: Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peripheral choIangiocarcinoma (Ch-Ca).Study Design: We reviewed our experience with,Ch-Ca to determine survival rates, recurrence patterns, and risk factors in 54 patients who underwent either hepatic resection or OLT between 1981 and 1994. Liver transplantation was performed in patients with unresectable tumors (n = 12) and in those with advanced cirrhosis (n = 8). There were 33 women (61%) and 21 men (39%), with a mean age of 54.3 years. The median followup period was 6.8 years. Prognostic risk factors were analyzed by univariate and multivariate analyses.Results: Mortality within 30 days was 7.4%. Overall patient and tumor-free survival rates were 64% and 57% at 1 year, 34% and 34% at 3 years, and 26% and 27% at 5 years after operation. Thirty-two patients (59.3%) experienced tumor recurrence. Univariate analysis revealed that multiple tumors, bilobar tumor distribution, regional lymph node involvement, presence of metastasis, positive surgical margins, and advanced pTNM stages were significant negative predictors of both tumor-free and patient survival. Multivariate analysis revealed that positive margins, multiple tumors, and lymph node involvement were independently associated with poor prognosis. When patients with these three negative predictors were excluded, the patient survivals at 1, 3, and 5 years were 74%, 64%, and 62%, respectively.Conclusions: Both hepatic resection and OLT are effective therapies for Ch-Ca when the tumor can be removed with adequate margins, the lesion is singular, and lymph nodes are not involved. (C) 1997 by the American College of Surgeons).