Bahra Marcus, Jacob Dietmar, Langrehr Jan M, Neumann Ulf P, Neuhaus Peter
Chirurgische Klinik und Poliklinik, Charité, Campus Virchow-Klinikum, Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany.
J Hepatobiliary Pancreat Surg. 2008;15(5):501-7. doi: 10.1007/s00534-007-1308-4. Epub 2008 Oct 4.
BACKGROUND/PURPOSE: Carcinoma of the distal bile duct is associated with poor prognosis. Surgical resection remains the only potentially curative treatment. We conducted a retrospective study to identify prognostic factors determining longterm survival.
From 1990 to 2006, 95 patients with distal and/or middle bile duct carcinoma had resections. Fifty-four patients underwent pylorus-preserving pancreaticoduodenectomy (57%) and 41 patients underwent standard Kausch-Whipple pancreaticoduodenectomy (43%). Nine patients underwent pancreaticoduodenectomy including portal vein resection (9%).
Overall 1-, 3-, and 5-year survival rates were 60%, 36%, and 29%, respectively. Five-year survival after R0 resection was 34%, and after R1 resection it was 0%. Four patients died during their hospital stay (4%). Multivariate analysis showed negative resection margins (P = 0.040), lymphatic vessel invasion (P = 0.036), and portal vein infiltration (P = 0.027) as strong predictors for survival, whereas the location of the tumor (distal bile duct vs middle bile duct) and lymph node status were not identified as independent prognostic factors.
Five-year survival depends strongly on negative resection margins, independent of nodal status. Portal vein resections in patients with portal vein involvement fail to ameliorate long-term survival. Primary tumor site--middle bile duct or distal bile duct--did not determine prognosis.
背景/目的：远端胆管癌预后较差。手术切除仍然是唯一可能治愈的治疗方法。我们进行了一项回顾性研究，以确定决定长期生存的预后因素。
1990年至2006年，95例远端和/或中段胆管癌患者接受了手术切除。54例患者接受了保留幽门的胰十二指肠切除术（57%），41例患者接受了标准的考施-惠普尔胰十二指肠切除术（43%）。9例患者接受了包括门静脉切除的胰十二指肠切除术（9%）。
总体1年、3年和5年生存率分别为60%、36%和29%。R0切除术后5年生存率为34%，R1切除术后为0%。4例患者在住院期间死亡（4%）。多因素分析显示切缘阴性（P = 0.040）、淋巴管侵犯（P = 0.036）和门静脉浸润（P = 0.027）是生存的强预测因素，而肿瘤位置（远端胆管与中段胆管）和淋巴结状态未被确定为独立的预后因素。
5年生存率很大程度上取决于切缘阴性，与淋巴结状态无关。门静脉受累患者的门静脉切除术未能改善长期生存。原发性肿瘤部位（中段胆管或远端胆管）不能决定预后。
