Yedibela Süleyman, Demir Resit, Zhang Wei, Meyer Thomas, Hohenberger Werner, Schönleben Frank
Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig, Germany.
Ann Surg Oncol. 2009 Feb;16(2):404-12. doi: 10.1245/s10434-008-0227-1. Epub 2008 Nov 27.
Hepatic resection is the only cure for intrahepatic cholangiocellular carcinoma (ICC). The purpose of this study was to clarify the clinicopathologic characteristics and surgical outcome of patients with ICC. We retrospectively studied the records of 67 patients who underwent laparotomy for ICC from January 1995 through December 2005. Univariate and multivariate analyses were conducted for several variables to evaluate their influence on the outcome. Forty-five patients underwent hepatic resection. In 19 patients, the tumors were found to be unresectable at the time of laparotomy. Median 2- and 5-year survival rates in the 45 resected patients were 62% and 35%, respectively. For 36 patients who underwent curative resection, the 2- and 5-year survival were 67% and 41%, respectively; with a median survival of 43 months. The overall 5-year recurrence-free survival was 30%. The 90-day postoperative mortality rate was 4% and morbidity 28%. Multivariate analyses confirmed resection margin, lymph node involvement, blood loss, and blood transfusion to be independent significant variables for overall survival. Predictors of longer recurrence-free survival were lymph node involvement, vascular infiltration, blood loss, and transfusion. Surgical treatment of ICC by curative hepatic resection in patients without nodal invasion provides good long-term results. In contrast, incomplete tumor removal does not provide a survival benefit. An improved quality of preoperative staging was able to increase the resectability rate to acceptable 70%.
肝切除术是肝内胆管细胞癌（ICC）的唯一治愈方法。本研究的目的是阐明ICC患者的临床病理特征及手术结果。我们回顾性研究了1995年1月至2005年12月期间因ICC接受剖腹手术的67例患者的记录。对几个变量进行单因素和多因素分析，以评估它们对结果的影响。45例患者接受了肝切除术。19例患者在剖腹手术时发现肿瘤无法切除。45例接受切除患者的2年和5年生存率中位数分别为62%和35%。36例接受根治性切除的患者，2年和5年生存率分别为67%和41%；中位生存期为43个月。总体5年无复发生存率为30%。术后90天死亡率为4%，发病率为28%。多因素分析证实切缘、淋巴结受累、失血量和输血是总生存的独立显著变量。无复发生存期较长的预测因素是淋巴结受累、血管浸润、失血量和输血。对无淋巴结侵犯的患者行根治性肝切除术治疗ICC可取得良好的长期效果。相比之下，肿瘤切除不完全并不能带来生存益处。术前分期质量的提高能够将可切除率提高到可接受的70%。
