Kobayashi A, Miwa S, Nakata T, Miyagawa S
First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan.
Br J Surg. 2010 Jan;97(1):56-64. doi: 10.1002/bjs.6788.
There is little information regarding the clinical behaviour of hilar cholangiocarcinoma after curative resection.
A retrospective study was undertaken of 79 consecutive patients with hilar cholangiocarcinoma who had undergone major hepatectomy (three or more Couinaud segments) concomitant with caudate lobectomy, and had negative resection margins. Sites of initial disease recurrence were classified as locoregional (porta hepatis) or distant (intrahepatic, peritoneal, para-aortic lymph nodal or extra-abdominal). Univariable and multivariable analyses were performed to determine the factors potentially related to recurrence.
Disease recurrence was observed in 42 (53 per cent) of the 79 patients. Cumulative recurrence rates at 3 and 4 years after surgery were 52 and 56 per cent respectively. Locoregional recurrence alone was observed in eight (10 per cent) and distant metastasis in 34 (43 per cent) of the 79 patients after R0 resection. Positive nodal involvement and high International Union Against Cancer tumour (T) stage were independent prognostic factors associated with distant metastasis.
Distant metastases are more common than locoregional recurrence after R0 resection for hilar cholangiocarcinoma, and associated with nodal involvement and high T stage.
关于肝门部胆管癌根治性切除术后的临床行为，相关信息较少。
对79例连续的肝门部胆管癌患者进行回顾性研究，这些患者均接受了扩大肝切除术（三个或更多Couinaud肝段）并同时行尾状叶切除术，且手术切缘阴性。初始疾病复发部位分为局部区域（肝门部）或远处（肝内、腹膜、腹主动脉旁淋巴结或腹外）。进行单因素和多因素分析以确定可能与复发相关的因素。
79例患者中有42例（53%）出现疾病复发。术后3年和4年的累积复发率分别为52%和56%。在79例患者中，R0切除术后仅观察到8例（10%）局部区域复发和34例（43%）远处转移。阳性淋巴结受累和国际抗癌联盟高肿瘤（T）分期是与远处转移相关的独立预后因素。
对于肝门部胆管癌，R0切除术后远处转移比局部区域复发更常见，且与淋巴结受累和高T分期相关。
