Prognostic factors of surgical resection in middle and distal bile duct cancer: An-analysis of 55 patients concerning the significance of ductal and radial margins
Prognostic factors of surgical resection in middle and distal bile duct cancer: An-analysis of 55 patients concerning the significance of ductal and radial margins
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DOI：
10.1016/j.surg.2004.10.008
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发表时间：
2005-04-01
期刊：
影响因子：
3.8
通讯作者：
Makuuchi, M
中科院分区：
文献类型：
--
作者：
Sakamoto, Y;Kosuge, T;Makuuchi, M
背景中段和/或远端胆管癌的手术结果仍然不令人满意。虽然切除边缘是一个预测因素，但导管边缘和其他放射状边缘阳性的预后意义从未被独立评估。方法.方法回顾性分析1987 ~ 2003年间55例中、下段胆管癌手术切除的临床病理资料。手术方式包括胰管切除42例（76%）、肝外胆管切除8例（15%）、半肝切除3例（5%）、胰管切除加肝切除2例（4%）。在所有患者中，术中诊断的导管边缘进行冷冻切片。21个临床病理因素，包括导管边缘和其他放射状边缘的状态，进行了评估，使用单变量和多变量分析。结果总的5年生存率和中位生存时间分别为24%和38个月。术后死亡4例（7%）。其余51例患者中有15例（29%）在手术中确定为肝侧胆管切缘阳性，其中14例接受了额外的胆管切除术（平均1.6 [范围，1-3]次）。结果，肝侧导管边缘（hm）和肾侧导管边缘在最终病理分析中分别有6例和0例阳性。到目前为止，6例HM阳性的患者中有2例（33%）发生了乳腺导管复发，但HM的状态并不是一个重要的预测因素。单因素分析显示，肿瘤浸润深度、胰腺浸润、桡侧切缘及输血是影响预后的重要因素。多因素分析显示肿瘤浸润深度和输血是影响预后的独立因素。结论.在中、远端胆管癌的治疗中，确保放射状切缘阴性是很重要的，尽管获得一个阴性的hm可能没有那么有利。外科医生应努力获得阴性放射状切缘并避免输血。
Background. The surgical outcome of middle and/or distal bile duct cancer remains unsatisfactory. Although the resectional margin is known to be a predictive factor, the prognostic significance of a positive ductal margin and other radial margin has never been evaluated independently. Methods. The clinicopathologic data of 55 patients who had undergone surgical resection for middle and/or distal bile duct cancer between 1987 and 2003 were reviewed retrospectively. The surgical procedures consisted of pancreatoduodenectomy in 42 patients (76%), extrahepatic bile duct resection in 8 patients (15%), major hemihepatectomy (Hx) in 3 patients (5%), and pancreatoduodenectomy plus Hx in 2 patients (4%). In all the patients, intraoperative diagnosis of the ductal margins was performed using frozen sections. Twenty-one clinicopathologic factors, including the status of the ductal margins and of other radial margins, were evaluated using univariate and multivariate analyses. Results. The overall 5-year survival rate and the median survival time were 24% and 38 months, respectively. There were 4 (7%) postoperative deaths. Fifteen of the remaining 51 patients (29%) were determined to have positive hepatic-side ductal margins during operation, and 14 of them underwent additional resection of the bile duct (1.6 [range, 1-3] times, on average). As a result, hepatic-side ductal margin (hm) and duodenal-side ductal margin were,found to be positive in 6 and 0 patients on the final pathologic analysis, respectively. Two of the 6 patients (33%) with positive hm have developed ductal recurrence so far, but the status of hm was not found to be a significant predictor. The depth of neoplastic invasion into the bile duct wall, pancreatic invasion, radial margin, and blood transfusion were significant prognostic factors by the univariate analysis. Multivariate analysis revealed that the depth of neoplastic invasion and blood transfusion were the independent prognostic factors. Conclusions. In the treatment of middle and distal bile duct cancer, it is of importance to secure a negative radial margin, although it may be less beneficial to obtain a negative hm. Surgeons should make efforts to obtain negative radial margins and to avoid blood transfusion.