Giuliante Felice, Gauzolino Riccardo, Vellone Maria, Ardito Francesco, Murazio Marino, Nuzzo Gennaro
Department of Surgical Sciences, Unit of Hepatobiliary Surgery, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
Tumori. 2005 Nov-Dec;91(6):487-92. doi: 10.1177/030089160509100608.
Intrahepatic cholangiocarcinoma (IHCC) is the second most common primary liver cancer, representing 10% of all primary liver malignancies. Despite the increase in its incidence, this tumor remains extremely rare in Western countries and few reports detailing experience with surgical resection have been published. The aim of this study was to analyze the experience with resection of IHCC in our center.
From 1987 to 2003 we observed 35 patients with IHCC; 15 of them (42.8%) were submitted to hepatic resection. IHCCs accounted for 13% of all liver resections for primary liver tumors carried out at our center during this period. According to the classification of the Liver Cancer Study Group of Japan, the tumors were classified as "mass-forming" in 14 cases and as "periductal" in one case. Major resections were performed in ten cases and minor resections in five cases. In the patient with a periductal tumor a major resection was performed along with excision of the main biliary confluence. In 14 cases (93.3%) tumor-free resection margins were obtained.
The intraoperative mortality was nil and the postoperative mortality 6.6%. The postoperative morbidity rate was 21.4%. The mean overall survival was 38.4 months, with 86% and 49% one- and three-year survival rates, respectively. Patients with mass-forming tumors and curative resections (R0) (mean survival 40.8 months; one- and three-year survival rates 92.3% and 52.7%), and those with TNM stage I-II tumors (mean survival 43.7 months; one- and three-year survival rates 100% and 66.7%) had a longer survival. The patient with the periductal tumor and R1 resection died after seven months.
These results support a surgical approach based on accurate selection of patients with IHCC and aimed at radical resection whenever possible. The good survival rates observed in R0 resections emphasize the role of radical surgery as the only chance of cure for patients with this tumor.
肝内胆管癌（IHCC）是第二常见的原发性肝癌，占所有原发性肝脏恶性肿瘤的10%。尽管其发病率有所上升，但在西方国家这种肿瘤仍然极为罕见，且很少有详细报道手术切除经验的文献发表。本研究的目的是分析我们中心IHCC切除手术的经验。
1987年至2003年，我们观察了35例IHCC患者；其中15例（42.8%）接受了肝切除手术。在此期间，IHCC占我们中心所有原发性肝脏肿瘤肝切除手术的13%。根据日本肝癌研究组的分类，14例肿瘤为“肿块型”，1例为“胆管周围型”。10例行大手术切除，5例行小手术切除。对于胆管周围型肿瘤患者，除切除主要胆管汇合处外还进行了大手术切除。14例（93.3%）获得了无瘤切缘。
术中死亡率为零，术后死亡率为6.6%。术后发病率为21.4%。平均总生存期为38.4个月，1年和3年生存率分别为86%和49%。肿块型肿瘤且行根治性切除（R0）的患者（平均生存期40.8个月；1年和3年生存率分别为92.3%和52.7%），以及TNM分期为I-II期肿瘤的患者（平均生存期43.7个月；1年和3年生存率分别为100%和66.7%）生存期更长。胆管周围型肿瘤且行R1切除的患者在7个月后死亡。
这些结果支持一种基于准确选择IHCC患者并尽可能进行根治性切除的手术方法。R0切除中观察到的良好生存率强调了根治性手术作为该肿瘤患者唯一治愈机会的作用。
