Ramacciato Giovanni, Nigri Giuseppe, Bellagamba Riccardo, Petrucciani Niccolò, Ravaioli Matteo, Cescon Matteo, Del Gaudio Massimo, Ercolani Giorgio, Di Benedetto Fabrizio, Cautero Nicola, Quintini Cristiano, Cucchetti Alessandro, Lauro Augusto, Miller Charles, Pinna Antonio Daniele
Department of General Surgery, Hepato-biliary-pancreatic Unit, University of Rome "La Sapienza," II School of Medicine, Sant'Andrea Hospital, Rome, Italy.
Am Surg. 2010 Nov;76(11):1260-8.
Surgery is the only effective treatment able to improve survival of patients with hilar cholangiocarcinoma (CCA). However, the significance of prognostic factors on overall survival is still debated. We evaluated early and long-term outcomes of patients resected for hilar cholangiocarcinoma over a 3-year period to determine the role of prognostic factors and their effect on overall survival. Medical records of patients with hilar CCA who underwent resection between January 2001 and December 2004 were retrospectively reviewed. Univariate and multivariate analysis was performed to identify prognostic factors associated with survival. Thirty-two of 45 patients underwent surgical resection with curative intent. Morbidity was 24.4 per cent; perioperative mortality was 0 per cent. Overall median survival was 22.3 months. Well-differentiated tumor grading and R0 resection were independently associated with better survival at multivariate analysis. Aggressive surgery, including biliary resection combined with major hepatectomy, is a safe procedure with low morbidity and mortality in a tertiary referral hepatobiliary center. The main aim of an aggressive surgical approach is to obtain a microscopic margin-negative resection, which is associated with better prognosis. Another important prognostic factor is tumor grading, which is independently associated with survival.
手术是唯一能够提高肝门部胆管癌（CCA）患者生存率的有效治疗方法。然而，预后因素对总生存的意义仍存在争议。我们评估了3年内接受肝门部胆管癌切除术患者的早期和长期结局，以确定预后因素的作用及其对总生存的影响。对2001年1月至2004年12月期间接受肝门部CCA切除术患者的病历进行回顾性分析。进行单因素和多因素分析以确定与生存相关的预后因素。45例患者中有32例接受了根治性手术切除。发病率为24.4%；围手术期死亡率为0%。总中位生存期为22.3个月。在多因素分析中，高分化肿瘤分级和R0切除与更好的生存独立相关。在三级转诊肝胆中心，包括胆管切除联合肝大部切除术在内的积极手术是一种安全的手术，发病率和死亡率较低。积极手术方法的主要目的是获得显微镜下切缘阴性的切除，这与更好的预后相关。另一个重要的预后因素是肿瘤分级，其与生存独立相关。
