Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution
Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution
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DOI：
10.1007/s00595-015-1119-1
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发表时间：
2016-01-01
期刊：
影响因子：
2.5
通讯作者：
Yamamoto, Masakazu
中科院分区：
文献类型：
--
作者：
Higuchi, Ryota;Ota, Takehiro;Yamamoto, Masakazu
目的本研究旨在研究40年期间肝门部胆管癌（HC）手术程序的变化和HC手术后患者的生存率。方法在1974年至2014年期间，239例连续患者接受了HC手术。围手术期治疗的变化和短期和长期的手术outcomes.Results肝大部切除（特别是右肝切除）和R 0切除率显着增加。失血量、输血率、发病率和手术死亡率均显著降低。1974-1988年的5年疾病特异性生存率为9.29%（n = 38），1989-2003年为41.1%（n = 88），2004-2008年为55.6%（n = 57（p = 0.0001：1974-1988 vs 1989-2003，p < 0.0001：1974-1988 vs 2004 - 2008，p = 0.076：1989-2003 vs 2004-2008）。根据多变量分析，Bispellet分级IV（人力资源与I，2.86），1989-2003年（人力资源对1974-1988年，0.31），2004-2008年（HR vs 1974-1988，0.26）和R1或R2切除结论40年来HC的手术治疗效果明显改善，这是由于积极的手术和手术技术的进步，围手术期处理，诊断工具。
Purpose This study aimed to examine the changes in procedures for hilar cholangiocarcinoma (HC) surgery and patient survival following HC surgery over a 40-year period.Methods Between 1974 and 2014, 239 consecutive patients underwent surgery for HC. The changes in perioperative therapy and short-and long-term surgical outcomes were evaluated.Results The rates of major hepatectomy (in particular, right hepatectomy) and R0 resection significantly increased. Blood loss, transfusion rate, morbidity, and surgical mortality all significantly decreased. The 5-year disease-specific survival was 9.29 % (n = 38) in 1974-1988, 41.1 % (n = 88) in 1989-2003 and 55.6 % (n = 57) in 2004-2008 (p = 0.0001: 1974-1988 vs 1989-2003, p < 0.0001: 1974-1988 vs 20042008, p = 0.076: 1989-2003 vs 2004-2008). According to a multivariate analysis, Bismuth classification IV (HR vs I, 2.86), period 1989-2003 (HR vs 1974-1988, 0.31), 2004-2008 (HR vs 1974-1988, 0.26), and R1 or R2 resection (HR vs R0, 2.22) were independent prognostic factors.Conclusion The surgical outcomes for HC over the 40-year period clearly improved as a result of aggressive surgery and progress in surgical techniques, perioperative management, and diagnostic tools.