Uenishi Takahiro, Kubo Shoji, Yamazaki Osamu, Yamada Terumasa, Sasaki Yo, Nagano Hiroaki, Monden Morito
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
J Hepatobiliary Pancreat Surg. 2008;15(4):417-22. doi: 10.1007/s00534-007-1315-5. Epub 2008 Aug 1.
BACKGROUND/PURPOSE: The postoperative outcome of patients who have intrahepatic cholangiocarcinoma with lymph node metastases is extremely poor, and the indications for surgery for such patients have yet to be clearly established.
The demographic and clinical characteristics of 133 patients who underwent lymph node dissection during hepatic resection of intrahepatic cholangiocarcinoma were retrospectively analyzed.
Multivariate analysis identified three independent prognostic factors: intrahepatic metastasis, nodal involvement, and tumor at the margin of resection. Of the patients with tumor-free surgical margins, none of the 24 patients who had both lymph node metastases and intrahepatic metastases survived for 3 years. In contrast, the survival rates for the 23 patients who had lymph node metastases associated with a solitary tumor were 35% at 3 years and 26% at 5 years.
Surgery alone cannot prolong survival when both lymph node metastases and intrahepatic metastases are present, while surgery may provide a chance for long-term survival in some patients who have lymph node metastases associated with a solitary intrahepatic cholangiocarcinoma tumor.
背景/目的：肝内胆管癌伴淋巴结转移患者的术后预后极差，此类患者的手术指征尚未明确确立。
回顾性分析133例行肝内胆管癌肝切除时行淋巴结清扫患者的人口统计学和临床特征。
多因素分析确定了三个独立的预后因素：肝内转移、淋巴结受累及切缘肿瘤。在手术切缘无肿瘤的患者中，24例同时有淋巴结转移和肝内转移的患者无一人存活3年。相比之下，23例有孤立肿瘤伴淋巴结转移患者的3年生存率为35%，5年生存率为26%。
当同时存在淋巴结转移和肝内转移时，单纯手术不能延长生存期，而手术可能为一些有孤立肝内胆管癌肿瘤伴淋巴结转移的患者提供长期生存的机会。
