Abdel Wahab M, Fathy O, Elghwalby N, Sultan A, Elebidy E, Abdalla T, Elshobary M, Mostafa M, Foad A, Kandeel T, Abdel Raouf A, Salah T, Abu Zeid M, Abu Elenein A, Gad Elhak N, ElFiky A, Ezzat F
Gastroenterology Center, Mansoura University, Egypt.
Hepatogastroenterology. 2006 Jan-Feb;53(67):5-10.
BACKGROUND/AIMS: Hilar cholangiocarcinoma, still a challenging problem for surgeons and resectional surgery, is the treatment of choice for long-term survival. In this study we tried to evaluate different prognostic factors after resection.
From January 1995 to October 2004, 440 patients with hilar cholangiocarcinoma were admitted to the Gastroenterology Surgical Center, Mansoura University, Egypt. Of these patients 73 underwent potentially curative resection giving respectability rate of 17%, and the remaining 367 patients underwent non-surgical treatment because of advanced disease, advanced cirrhosis and poor general condition. Of the 73 patients, 35 (48%) underwent localized hepatic resection and 38 (52%) patients underwent major hepatic resection. Various prognostic factors for survival were evaluated by univariate and multivariate analysis.
Hospital mortality occurred in 8 (11%) patients. The most common postoperative complications were: bile leak, liver cell failure and wound infection 23.2%, 17.8% and 9.5% respectively. The survival rates at 1, 2, 3, 4, and 5 years were 79%, 32.6, 18.5, 137% and 13% respectively. The result of univariate analysis revealed that radicality of resection, lymph nodes status, tumor differentiation, modified Bismuth staging, underlying liver pathology, HCV viral infection, blood transfusion, preoperative serum bilirubin <10mg and CA19-9 are dependent prognostic factors. By multivariate Cox analysis radicality of resection, lymph nodes status, serum bilirubin below 10mg/dL level of CA19-9 and hepatitis viral infection were independent predictor factors.
From this study we found that aggressive surgical procedure to obtain curative resection with preoperative serum bilirubin below 10mg and HCV infective negative especially in noncirrhotic liver may bring a better prognosis in hilar cholangiocarcinoma.
背景/目的：肝门部胆管癌仍然是外科医生面临的一个具有挑战性的问题，手术切除是实现长期生存的首选治疗方法。在本研究中，我们试图评估切除术后不同的预后因素。
1995年1月至2004年10月，440例肝门部胆管癌患者入住埃及曼苏拉大学胃肠外科中心。其中73例患者接受了可能治愈性切除，切除率为17%，其余367例患者因疾病进展、肝硬化晚期和全身状况差而接受非手术治疗。在这73例患者中，35例（48%）接受了局部肝切除，38例（52%）接受了大范围肝切除。通过单因素和多因素分析评估了各种生存预后因素。
8例（11%）患者发生医院死亡。最常见的术后并发症分别为胆漏、肝功能衰竭和伤口感染，发生率分别为23.2%、17.8%和9.5%。1年、2年、3年、4年和5年生存率分别为79%、32.6%、18.5%、13.7%和13%。单因素分析结果显示，切除的彻底性、淋巴结状态、肿瘤分化程度、改良Bismuth分期、肝脏基础病变、丙型肝炎病毒感染、输血、术前血清胆红素<10mg以及CA19-9是相关的预后因素。通过多因素Cox分析，切除的彻底性、淋巴结状态、血清胆红素低于10mg/dL、CA19-9水平以及肝炎病毒感染是独立的预测因素。
从本研究中我们发现，积极的手术操作以实现治愈性切除，术前血清胆红素低于10mg且丙型肝炎病毒感染阴性，尤其是在非肝硬化肝脏中，可能会给肝门部胆管癌带来更好的预后。
