Aggressive Surgical Resection for Hilar Cholangiocarcinoma of the Left-Side Predominance Radicality and Safety of Left-Sided Hepatectomy
Aggressive Surgical Resection for Hilar Cholangiocarcinoma of the Left-Side Predominance Radicality and Safety of Left-Sided Hepatectomy
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DOI：
10.1097/sla.0b013e3181be0085
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发表时间：
2010-02-01
影响因子：
9
通讯作者：
Miyazaki, Masaru
中科院分区：
文献类型：
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作者：
Shimizu, Hiroaki;Kimura, Fumio;Miyazaki, Masaru
目的：探讨肝门部胆管癌左半肝切除术（L-H）后的临床病理转归。背景资料：L-H适用于主要累及左肝管的HC的根治性手术。然而，一些报告表明，L-H往往导致肿瘤阳性边缘和不利的预后相比，右侧肝切除术（R-H）。方法：共有224例HC患者接受手术切除治疗的目的在我们的机构：L-H治疗88例B-C IIIb型肿瘤其中左半肝切除术75例，左三肝切除术13例，占39.3%; R-H主要用于B-C型伊利亚、IV型肿瘤84例，占37.5%。本研究调查了L-H后的临床病理结局、围手术期发病率和死亡率，并与R-H后进行比较。结果：L-H患者中有56例（63.6%）实现了组织学阴性边缘（R 0）切除，与R-H的结果相似（58/84，69.1%）。然而，在L-H病例中，门静脉（PV）切除的R 0切除率较低（11/25，44.0%），需要进行各种类型的PV重建。近端导管残端和导管周围结构的切除面是最常见的阳性边缘部位。然而，当实现根治性切除时，5年生存率与R-H病例相当。此外，L-H病例的死亡率较低，即使采用左侧三部分切除术。多变量分析表明，治愈性和肝动脉切除作为独立的预后factor.Conclusions：由于L-H是一个安全的程序，并代表了唯一的根治性切除术的选择IIIb型肿瘤，积极的手术切除，即使在PV参与的情况下，如果R 0切除是可能的。
Objectives: To evaluate the clinicopathologic outcomes in patients with hilar cholangiocarcinoma (HQ after left-sided hepatectomy (L-H). Summary Background Data: L-H is indicated as radical surgery for HC, predominantly involving left hepatic duct. However, several reports have demonstrated that L-H often results in tumor-positive margin and unfavorable prognosis compared with right-sided hepatectomy (R-H).Methods: A total of 224 patients with HC underwent surgical resection with curative intent at our institution: L-H for Bismuth-Corlette (B-C) type IIIb tumors in 88 patients (39.3%) including 75 left hemihepatectomies and 13 left trisectionectomies, and R-H mainly for B-C type Ilia and IV tumors in 84 patients (37.5%). In this study, clinicopathologic outcomes and perioperative morbidity and mortality rates after L-H were investigated and compared with those after R-H.Results: Histologically negative margin (R0) resection was achieved in 56 cases (63.6%) with L-H, similar to the results for R-H (58/84, 69.1%). However, the R0 resection rate in L-H cases with portal vein (PV) resection was lower (11/25, 44.0%), and various types of PV reconstruction were required. Proximal ductal stumps and excisional surface at periductal structures were the most common sites of positive margins. However, when curative resection was achieved, 5-year survival was comparable to that in R-H cases. Furthermore, lower mortality was noted in L-H cases, even with left trisectionectomy. Multivariate analysis indicated curability and hepatic artery resection as independent prognostic factors.Conclusions: Since L-H is a safe procedure and represents the only curative resectional option for type IIIb tumor, aggressive surgical resection should be performed even in cases with PV involvement, if R0 resection is possible.