Kaneoka Yuji, Yamaguchi Akihiro, Isogai Masatoshi, Kumada Takashi
Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-8502, Japan.
World J Surg. 2010 Nov;34(11):2662-70. doi: 10.1007/s00268-010-0702-2.
Perihilar and distal cholangiocarcinoma remain difficult to treat, and long-term survival is poor. We conducted a retrospective study of patients with cholangiocarcinoma to examine whether hepatopancreatoduodenectomy, in comparison to standard surgeries, provides a survival benefit.
Subjects were 75 patients with perihilar or distal cholangiocarcinoma who, between April 1997 and May 2007, underwent hepatectomy with bile duct resection (Hx, n = 29), pancreatoduodenectomy (PD, n = 32), or hepatopancreatoduodenectomy (HPD, n = 14) at our hospital. We compared surgical outcomes and survival between groups and identified factors negatively influencing survival.
Morbidity and in-hospital mortality did not differ significantly between groups (Hx group, 34% and 10%, respectively; PD group, 44% and 3%; and HPD, 57% and 0%). The overall median survival time was 39 months, and overall 5-year survival (including in-hospital mortality) was 42%. Respective group values were as follows: Hx, 24 months and 31%; PD, 51 months and 49%, and HPD, 63 months and 50%. Although the number of patients was small, survival in the HPD was not influenced by the type of invasion whether widespread intramural invasion (n = 8), superficial spread (n = 4), or hepatoduodenal ligament invasion (n = 2). Multivariate analysis (Cox proportional hazards model) showed only perineural invasion (p = .007) and decreased curability (R1/2 resection) (p = .017) to be independent risk factors influencing survival.
In cases of perihilar or distal cholangiocarcinoma, aggressive surgery must be aimed at overcoming perineural invasion. Our findings indicate that HPD improves survival of patients undergoing surgery for widespread cholangiocarcinoma in comparison to standard surgeries.
肝门部和远端胆管癌的治疗仍然困难，长期生存率较低。我们对胆管癌患者进行了一项回顾性研究，以检验与标准手术相比，肝胰十二指肠切除术是否能带来生存获益。
研究对象为75例肝门部或远端胆管癌患者，他们于1997年4月至2007年5月在我院接受了肝切除术联合胆管切除术（Hx组，n = 29）、胰十二指肠切除术（PD组，n = 32）或肝胰十二指肠切除术（HPD组，n = 14）。我们比较了各组的手术结果和生存率，并确定了对生存有负面影响的因素。
各组之间的发病率和住院死亡率无显著差异（Hx组分别为34%和10%；PD组分别为44%和3%；HPD组分别为57%和0%）。总体中位生存时间为39个月，总体5年生存率（包括住院死亡率）为42%。各组相应的值如下：Hx组为24个月和31%；PD组为51个月和49%；HPD组为63个月和50%。尽管患者数量较少，但HPD组的生存不受侵犯类型的影响，无论是广泛的壁内侵犯（n = 8）、浅表扩散（n = 4）还是肝十二指肠韧带侵犯（n = 2）。多因素分析（Cox比例风险模型）显示，只有神经周围侵犯（p = 0.007）和可切除性降低（R1/2切除）（p = 0.017）是影响生存的独立危险因素。
在肝门部或远端胆管癌病例中，积极的手术必须旨在克服神经周围侵犯。我们的研究结果表明，与标准手术相比，HPD可提高广泛胆管癌手术患者的生存率。
