Extended Bile Duct Resection Liver and Transplantation in Patients with Hilar Cholangiocarcinoma: Long-Term Results
Extended Bile Duct Resection Liver and Transplantation in Patients with Hilar Cholangiocarcinoma: Long-Term Results
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DOI：
10.1002/lt.21887
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发表时间：
2009-11-01
影响因子：
4.6
通讯作者：
Neuhaus, Peter
中科院分区：
文献类型：
--
作者：
Seehofer, Daniel;Thelen, Armin;Neuhaus, Peter
对于不可切除的肝门部胆管癌患者，由于新辅助放疗的数据有希望，目前正在重新评估肝移植（LT）。为了增加根治性，在我们最初的经验中，肝切除术联合胰头切除术[扩大胆管切除术（EBDR）]被用于治疗不可切除的肝门部胆管癌。1992年至1998年间，对16例患者进行了EBDR和LT。未进行新辅助或辅助治疗。国际癌症联盟的分期为I（n = 6）、IIA（5）、IIB（3）和IV（2）。为了评估手术激进性的增加，我们对8例肝门部胆管癌行LT而不行部分胰腺切除术的患者进行了配对分析。EBDR术后1年、5年和10年患者生存率分别为63%、38%和38%。12名患者死亡：2例死于术后并发症，8例死于肿瘤复发，2例死于移植后10年以上无复发。6例I期患者中，仅1例肿瘤复发，2例因术后并发症死亡。以下因素显示了生存率较低的趋势：远处转移、淋巴结阳性、高碳水化合物抗原19-9水平和术前经皮经鞘胆管引流。排除围手术期死亡后，所有淋巴结阴性患者的10年生存率为56%。总之，在我们的非同质队列中，总体长期生存率相对较低，但在无转移的患者中有利。然而，由于围手术期死亡率增加，EBDR不推荐作为肝门部胆管癌的标准手术，而不是单独的LT。为了进一步改善结果，必须越来越多地研究其他方法，如（新）辅助治疗。肝移植15：1499-1507，2009。(C)2009年AASLD。
For patients with irresectable hilar cholangiocarcinoma, liver transplantation (LT) is currently being reassessed because of promising data for neoadjuvant radiochemotherapy. For increased radicality, hepatectomy in combination with pancreatic head resection [extended bile duct resection (EBDR)] was performed for irresectable hilar cholangiocarcinoma during our initial experience. EBDR and LT was performed in 16 patients between 1992 and 1998. No neoadjuvant or adjuvant treatment was performed. The Union Internationale Contre le Cancer stages were I (n = 6), IIA (5), IIB (3), and IV (2). To evaluate the suspected increase in surgical radicality, a matched pair analysis was performed with 8 patients undergoing LT for hilar cholangiocarcinoma without partial pancreatoduodenectomy. The 1-, 5-, and 10-year patient survival rates after EBDR were 63%, 38%, and 38%, respectively. Twelve patients died: 2 died because of postoperative complications, 8 died because of tumor recurrence, and 2 died while recurrence-free more than 10 years after transplantation. Among the 6 stage I patients, only 1 developed tumor recurrence, but 2 died because of postoperative complications. The following factors showed a trend toward inferior survival: distant metastases, positive lymph nodes, high carbohydrate antigen 19-9 levels, and preoperative percutaneous transhepatic cholangiodrainage. When all lymph node-negative patients were considered after the exclusion of perioperative deaths, 10-year survival was 56%. In conclusion, the overall long-term survival was relatively low in our inhomogeneous cohort but favorable in patients without metastases. However, because of the increased perioperative mortality, EBDR is not recommended as a standard procedure for hilar cholangiocarcinoma instead of LT alone. To further improve the results, other approaches such as (neo)adjuvant therapy have to be increasingly investigated. Liver Transpl 15: 1499-1507, 2009. (C) 2009 AASLD.