Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
J Hepatobiliary Pancreat Sci. 2010 Jul;17(4):463-9. doi: 10.1007/s00534-009-0206-3. Epub 2009 Nov 26.
BACKGROUND/PURPOSE: Hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma involving the hepatic hilus are defined as "perihilar cholangiocarcinoma". The principle of surgical treatment is hemi-hepatectomy or trisectionectomy of the liver, caudate lobectomy, and resection of the extrahepatic bile duct for complete resection of the tumor. The aim of this study was to review the outcomes of major hepatectomy for perihilar cholangiocarcinoma.
Using the Kaplan-Meier method and the Cox proportional hazards model, we analyzed the results in 125 patients with perihilar cholangiocarcinoma who had undergone major hepatectomy.
Right hepatectomy, right trisectionectomy, left hepatectomy, and left trisectionectomy were performed in 66, 8, 49, and 2 patients, respectively. Curative resection was achieved in 79 patients (63.2%). Mortality and morbidity rates were 8.0 and 48.7%, respectively. The overall 1-, 3-, and 5-year survival rates of all patients were 73.2, 36.7, and 34.7%, respectively. The median survival was 26.8 months. Multivariate analysis showed that the independent prognostic factors for overall survival were gender, histopathological grading, curative resection, and American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) pT.
Major hepatectomy for perihilar cholangiocarcinoma was acceptable and showed satisfactory outcomes. For long-term survival in these patients, the surgeon should aim for complete resection of the tumor with negative margins.
背景/目的：肝门部胆管癌和累及肝门的肝内胆管癌被定义为“肝门周围胆管癌”。手术治疗原则是半肝或三叶肝切除术、尾状叶切除术和肝外胆管切除术，以完全切除肿瘤。本研究旨在回顾肝门周围胆管癌行根治性肝切除术的结果。
采用 Kaplan-Meier 法和 Cox 比例风险模型，对 125 例行根治性肝切除术的肝门周围胆管癌患者的结果进行分析。
66 例行右半肝切除术，8 例行右三叶切除术，49 例行左半肝切除术，2 例行左三叶切除术。79 例患者获得根治性切除（63.2%）。死亡率和发病率分别为 8.0%和 48.7%。所有患者的总 1、3 和 5 年生存率分别为 73.2%、36.7%和 34.7%。中位生存时间为 26.8 个月。多因素分析显示，总生存的独立预后因素为性别、组织病理学分级、根治性切除和美国癌症联合委员会/国际抗癌联盟（AJCC/UICC）pT。
肝门周围胆管癌行根治性肝切除术是可行的，且效果令人满意。对于这些患者的长期生存，外科医生应努力实现肿瘤的完全切除和阴性切缘。
