Aloia Thomas A, Charnsangavej Chusilp, Faria Silvana, Ribero Dario, Abdalla Eddie K, Vauthey J Nicholas, Curley Steven A
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Am J Surg. 2007 Jun;193(6):702-6. doi: 10.1016/j.amjsurg.2006.10.024.
Despite the use of radiologic, endoscopic, and laparoscopic staging techniques, the rate of nontherapeutic laparotomies in patients with hilar cholangiocarcinoma remains high. This study evaluated the accuracy of preoperative high-resolution computed tomography (HRCT) to determine resectability in this setting.
Preoperative helical HRCT (2 contrast phases, rapid intravenous contrast bolus, 2.5-mm section thickness) for 32 consecutive patients who underwent laparotomy for the diagnosis of hilar cholangiocarcinoma from 2000 to 2005 were reviewed by a hepatobiliary radiologist. The accuracy of HRCT was determined by comparison of the imaging interpretation to intraoperative and pathologic findings. The chi-square test was used to identify imaging findings that best predicted unresectability.
Fourteen of the 32 (44%) study patients were unresectable (extension along bile duct, 4; peritoneal metastases, 4; vascular encasement, 3; noncontiguous liver metastases, 2; N2 lymphadenopathy, 1). HRCT correctly predicted resectability in 17 of 18 patients who underwent therapeutic laparotomy (sensitivity = 94%). HRCT correctly predicted the inability to resect in 11 of the remaining 14 cases (specificity = 79%). In the 3 cases in which HRCT predicted resectability and the patient was unresectable, subcentimeter peritoneal disease, a subcentimeter liver metastasis, and distal bile duct involvement were responsible factors. The negative and positive predictive values of HRCT were 92% and 85%, respectively. Individual radiographic findings that best predicted unresectability were peritoneal spread (P = .015) and hepatic artery (P = .006) or portal vein (P = .002) involvement.
Preoperative HRCT accurately predicts resectability in patients with hilar cholangiocarcinoma. Identification of specific radiographic features, in particular major vascular involvement and peritoneal abnormalities, is now used by our group to avoid unnecessary laparotomy.
尽管使用了放射学、内镜和腹腔镜分期技术，但肝门部胆管癌患者的非治疗性剖腹手术率仍然很高。本研究评估了术前高分辨率计算机断层扫描（HRCT）在这种情况下确定可切除性的准确性。
一位肝胆放射科医生回顾了2000年至2005年连续32例因诊断肝门部胆管癌而接受剖腹手术患者的术前螺旋HRCT（2个对比期，快速静脉注射造影剂团注，层厚2.5毫米）。通过将影像学解释与术中及病理结果进行比较来确定HRCT的准确性。采用卡方检验来识别最能预测不可切除性的影像学表现。
32例研究患者中有14例（44%）不可切除（胆管侵犯，4例；腹膜转移，4例；血管包绕，3例；不连续肝转移，2例；N2淋巴结病，1例）。HRCT正确预测了18例接受治疗性剖腹手术患者中的17例的可切除性（敏感性=94%）。HRCT正确预测了其余14例中的11例无法切除（特异性=79%）。在HRCT预测可切除但患者不可切除的3例中，小于1厘米的腹膜病变、小于1厘米的肝转移和远端胆管受累是相关因素。HRCT的阴性和阳性预测值分别为92%和85%。最能预测不可切除性的个体影像学表现是腹膜播散（P=0.015）以及肝动脉（P=0.006）或门静脉（P=0.002）受累。
术前HRCT能准确预测肝门部胆管癌患者的可切除性。我们团队现在利用识别特定的影像学特征，特别是主要血管受累和腹膜异常，来避免不必要的剖腹手术。
