Lang Hauke, Sotiropoulos Georgios C, Sgourakis George, Schmitz Klaus J, Paul Andreas, Hilgard Philip, Zöpf Thomas, Trarbach Tanja, Malagó Massimo, Baba Hideo A, Broelsch Christoph E
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
J Am Coll Surg. 2009 Feb;208(2):218-28. doi: 10.1016/j.jamcollsurg.2008.10.017.
Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver malignancy. Until now, outcomes and prognostic factors after liver resection for these tumors have not been well-documented.
Between April 1998 and December 2006, a total of 158 patients underwent surgical exploration in our institution for intended liver resection of ICC. Prospectively collected data of patients undergoing liver resection (n = 83) were analyzed with regard to preoperative findings, operative details, perioperative morbidity and mortality, pathologic findings, outcomes measured by tumor recurrence and survival, and prognostic factors for outcomes.
Tumors were solitary in 47 patients. R0 resections were achieved in 53 patients. Vascular infiltration and lymph node metastasis were detected in 41% and 34%, respectively. After resection, the calculated 1-, 3-, and 5-year-survival rates were 71%, 38%, and 21%, respectively, with corresponding rates of 83%, 50%, and 30% in R0 resections. For 14 variables evaluated, only gender (p = 0.008), Union Internationale Contre le Cancer stage (p = 0.014), and R classification (p = 0.001) showed predictive value in the multivariate Cox proportional hazard regression.
Results presented outline that an R0 resection leads to substantially prolonged survival in ICC and represents the considerable input of the surgeon to the outcomes of these patients. Union Internationale Contre le Cancer stage remains an important factor.
肝内胆管癌（ICC）是一种罕见的原发性肝脏恶性肿瘤。迄今为止，这些肿瘤肝切除术后的结果及预后因素尚未得到充分记录。
1998年4月至2006年12月期间，共有158例患者在我院接受了旨在切除ICC的肝脏手术探查。对前瞻性收集的行肝切除术患者（n = 83）的数据进行分析，内容包括术前检查结果、手术细节、围手术期发病率和死亡率、病理检查结果、以肿瘤复发和生存衡量的结果以及结果的预后因素。
47例患者的肿瘤为单发。53例患者实现了R0切除。血管侵犯和淋巴结转移的检出率分别为41%和34%。切除术后，计算得出的1年、3年和5年生存率分别为71%、38%和21%，R0切除患者的相应生存率分别为83%、50%和30%。对于评估的14个变量，在多因素Cox比例风险回归中，只有性别（p = 0.008）、国际抗癌联盟（Union Internationale Contre le Cancer）分期（p = 0.014）和R分级（p = 0.001）显示出预测价值。
所呈现的结果表明，R0切除可显著延长ICC患者的生存期，并且体现了外科医生对这些患者预后的重要作用。国际抗癌联盟分期仍然是一个重要因素。
