Results of surgical resection for patients with hilar bile duct cancer - Application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization
Results of surgical resection for patients with hilar bile duct cancer - Application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization
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DOI：
10.1097/01.sla.0000074984.83031.02
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发表时间：
2003-07-01
影响因子：
9
通讯作者：
Miyagawa, S
中科院分区：
文献类型：
--
作者：
Kawasaki, S;Imamura, H;Miyagawa, S
目的：评估肝门部胆管癌患者采用胆道引流后肝切除和术前门静脉栓塞的积极手术方法的可行性。尽管许多外科医生强调肝大部切除术对肝门部胆管癌患者的根治性切除的重要性，这种方法导致胆汁淤积引起肝功能受损患者术后发病率和死亡率高。对1990年至2001年接受治疗的140例肝门部胆管癌患者进行了回顾性队列研究。79例患者行切除手术，其中69例接受了大肝切除术。13例患者接受了同期胰腺切除术。65例梗阻性黄疸患者术前均行胆道引流术。在51例接受扩大右半肝切除术的患者中，41例进行了门静脉栓塞。短期和长期的结果进行了evaluated.Results：没有病人发生术后肝功能衰竭（最高总胆红素水平，5.4毫克/分升）。住院死亡率为1.3%（1/79，死于脑梗死）。当进行计划的扩大肝切除时，组织学阴性切除边缘更常见（75% vs 44%，P = 0.0178）。当组织学切缘阴性时，估计5年生存率为40%，但如果切缘阳性，则仅为6%。多因素分析确定了切除边缘和淋巴结的状态作为独立的因素预测survival.Conclusions：广泛的切除，主要是扩大右半肝切除术后，胆道引流和术前门静脉栓塞，必要时，肝门部胆管癌患者可以安全地进行，更容易导致组织学阴性边缘比其他切除方法。
Objective: To evaluate the feasibility of an aggressive surgical approach incorporating major hepatic resection after biliary drainage and preoperative portal vein embolization for patients with hilar bile duct cancer.Summary Background Data: Although many surgeons have emphasized the importance of major hepatectomy in terms of curative resection for patients with hilar bile duct cancer, this procedure results in a high incidence of postoperative morbidity and mortality in patients with cholestasis-induced impaired liver function.Methods: A retrospective cohort study was conducted in 140 patients with hilar bile duct cancer treated from 1990 through 2001. Resectional surgery was performed in 79 patients, 69 of whom underwent major hepatic resection. Thirteen patients underwent concomitant pancreaticoduodenectomy. Preoperative biliary drainage was carried out in all 65 patients who had obstructive jaundice. Portal vein embolization was conducted in 41 of 51 patients undergoing extended right hepatectomy. Short- and long-term outcomes were evaluated.Results: No patient experienced postoperative liver failure (maximum total bilirubin level, 5.4 mg/dL). The in-hospital mortality rate was 1.3% (1 in 79, resulting from cerebral infarction). A histologically negative resection margin was obtained more frequently when the scheduled extended hepatic resection was conducted (75% vs 44%, P = 0.0178). The estimated 5-year survival rate was 40% when histologically negative resection margins were obtained, but only 6% if the margins were positive. Multivariate analysis identified the resection margin and nodal status as independent factors predictive of survival.Conclusions: Extensive resection, mainly extended right hemihepatectomy, after biliary drainage and preoperative portal vein embolization, when necessary, for patients with hilar bile duct cancer can be performed safely and is more likely to result in histologically negative margins than other resection methods.