Major hepatectomy for perihilar cholangiocarcinoma
Major hepatectomy for perihilar cholangiocarcinoma
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DOI：
10.1007/s00534-009-0206-3
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发表时间：
2010-07-01
影响因子：
3
通讯作者：
Egawa, Shinichi
中科院分区：
文献类型：
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作者：
Unno, Michiaki;Katayose, Yu;Egawa, Shinichi
肝门部胆管癌和累及肝门部的肝内胆管癌被定义为“肝门周围胆管癌”。手术治疗原则为半肝切除或肝三部分切除、尾状叶切除、肝外胆管切除，以达到肿瘤的完全切除。本研究的目的是回顾肝门部胆管癌的肝大部切除术的结果，使用Kaplan-Meier方法和考克斯比例风险模型，我们分析了125例肝门部胆管癌患者接受肝大部切除术的结果，其中66例患者接受了右肝切除术，8例患者接受了右三部分切除术，49例患者接受了左肝切除术，2例患者接受了左三部分切除术。79例患者（63.2%）实现了根治性切除。死亡率和发病率分别为8.0%和48.7%。所有患者的总体1年、3年和5年生存率分别为73.2%、36.7%和34.7%。中位生存期为26.8个月。多因素分析显示，影响总生存率的独立预后因素为性别、病理分级、根治性切除、美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）pT。肝门周胆管癌行肝大部切除术是可以接受的，并显示了满意的结果。为了这些患者的长期生存，外科医生应致力于完全切除肿瘤，切缘阴性。
Hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma involving the hepatic hilus are defined as "perihilar cholangiocarcinoma". The principle of surgical treatment is hemi-hepatectomy or trisectionectomy of the liver, caudate lobectomy, and resection of the extrahepatic bile duct for complete resection of the tumor. The aim of this study was to review the outcomes of major hepatectomy for perihilar cholangiocarcinoma.Using the Kaplan-Meier method and the Cox proportional hazards model, we analyzed the results in 125 patients with perihilar cholangiocarcinoma who had undergone major hepatectomy.Right hepatectomy, right trisectionectomy, left hepatectomy, and left trisectionectomy were performed in 66, 8, 49, and 2 patients, respectively. Curative resection was achieved in 79 patients (63.2%). Mortality and morbidity rates were 8.0 and 48.7%, respectively. The overall 1-, 3-, and 5-year survival rates of all patients were 73.2, 36.7, and 34.7%, respectively. The median survival was 26.8 months. Multivariate analysis showed that the independent prognostic factors for overall survival were gender, histopathological grading, curative resection, and American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) pT.Major hepatectomy for perihilar cholangiocarcinoma was acceptable and showed satisfactory outcomes. For long-term survival in these patients, the surgeon should aim for complete resection of the tumor with negative margins.