Ramacciato G, Corigliano N, Mercantini P, Di Benedetto F, Masetti M, Ercolani G, Lauro A, De Ruvo N, Pinna A-D
Service de Chirurgie Hépatobiliopancréatique, 2(e) Faculté de Médecine et Chirurgie, Université de Rome La Sapienza, Hôpital Sant'Andrea, 1035-1039, via di Grottarossa, 00189 Rome, Italie.
Ann Chir. 2006 Jul-Aug;131(6-7):379-85. doi: 10.1016/j.anchir.2006.03.006. Epub 2006 Mar 31.
To evaluate short and long-term results in 23 patients resected for hilar cholangiocarcinoma.
Between January 2001 and December 2003, 23 patients with hilar cholangiocarcinoma were resected and considered for retrospective analysis. Univariate and multivariate analysis were performed on several clinicopathological variables in order to evaluate the short-term results. Median follow-up was 11 months (interquartile range 2-20 months).
A major liver resection was performed in 19 out of 23 patients (82%): a right hepatectomy extended to segment 4 in 5 patients and a left hepatectomy in 14 patients. Resection of the caudate lobe was performed in 7 patients (30%). No hospital mortality occurred. Overall morbidity rate was 43%. The 1-year survival rate was 63.2% with a median survival of 19 months. Tumor recurrence appeared in 12 patients (52%). Low preoperative albumin level (P=0.006), presence of positive resection margin (P=0.03) and T-stage (P=0.02) were found to be related to a worse median survival. On multivariate analysis, only the preoperative albumin level and the presence of positive margin were confirmed as independent prognostic factors.
Aggressive surgical approach remains the only potentially curative therapy for the hilar cholangiocarcinoma. Low preoperative albumin level, presence of positive resection margin and T-stage resulted as factors influencing the prognosis after resection.
评估23例肝门部胆管癌切除术患者的短期和长期结果。
2001年1月至2003年12月期间，23例肝门部胆管癌患者接受了手术切除并进行回顾性分析。对多个临床病理变量进行单因素和多因素分析以评估短期结果。中位随访时间为11个月（四分位间距为2 - 20个月）。
23例患者中有19例（82%）进行了大范围肝切除：5例患者行右半肝切除并延伸至第4段，14例患者行左半肝切除。7例患者（30%）进行了尾状叶切除。无医院死亡病例。总体发病率为43%。1年生存率为63.2%，中位生存期为19个月。12例患者（52%）出现肿瘤复发。术前白蛋白水平低（P = 0.006）、切缘阳性（P = 0.03）和T分期（P = 0.02）与较差的中位生存期相关。多因素分析显示，只有术前白蛋白水平和切缘阳性被确认为独立的预后因素。
积极的手术方法仍然是肝门部胆管癌唯一可能的治愈性治疗方法。术前白蛋白水平低、切缘阳性和T分期是影响切除术后预后的因素。
