Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
HPB (Oxford). 2011 Feb;13(2):139-47. doi: 10.1111/j.1477-2574.2010.00262.x. Epub 2010 Dec 7.
The purpose of the present study was to demonstrate that post-operative morbidity (PM) associated with resections of hilar cholangiocarcinoma (HCCA) is associated with short- and long-term patient survival.
Between 1998 and 2008, 51 patients with a median age of 64 years underwent resection for HCCA at a single institution. Associations between survival and clinicopathologic factors, including peri- and post-operative variables, were studied using univariate and multivariate models.
Seventy-six per cent of patients underwent major hepatectomy with resection of the extrahepatic bile ducts. The 30- and 90-day operative mortality was 10% and 12%. The overall incidence of PM was 69%, with 68% of all PM as major (Clavien grades III-V). No difference in operative blood loss or peri-operative transfusion rates was observed for patients with major vs. minor or no PM. Patients with major PM received adjuvant chemotherapy less frequently than patients with minor or no complications 29% vs. 52%, P= 0.15. The 1-, 3- and 5-year overall (OS) and disease-specific survival (DSS) rates for all patients were 65%, 36%, 29% and 77%, 46%, 35%, respectively. Using univariate and multivariate analysis, margin status (27% R1), nodal metastasis (35% N1) and major PM were associated with OS and DSS, P < 0.01. Major PM was an independent factor associated with decreased OS and DSS [hazard ratio (HR) = 3.6 and 2.8, respectively, P < 0.05]. The median DSS for patients with major PM was 14 months compared with 40 months for patients who experienced minor or no PM, P < 0.01.
Extensive operations for HCCA can produce substantial post-operative morbidity. In addition to causing early mortality, major post-operative complications are associated with decreased long-term cancer-specific survival after resection of HCCA.
本研究旨在证明肝门部胆管癌（HCCA）切除术后的发病率（PM）与短期和长期患者生存率相关。
1998 年至 2008 年间，在一家机构对 51 名中位年龄为 64 岁的 HCCA 患者进行了切除术。使用单变量和多变量模型研究了生存率与临床病理因素之间的关系，包括围手术期和术后变量。
76%的患者接受了肝叶切除术和肝外胆管切除术。30 天和 90 天的手术死亡率为 10%和 12%。整体 PM 发生率为 69%，其中 68%为主要（Clavien 分级 III-V）。主要 PM 患者与次要或无 PM 患者的手术失血量或围手术期输血率无差异。接受辅助化疗的主要 PM 患者明显少于接受轻微或无并发症的患者 29%比 52%，P=0.15。所有患者的 1 年、3 年和 5 年总生存率（OS）和疾病特异性生存率（DSS）分别为 65%、36%、29%和 77%、46%、35%。使用单变量和多变量分析，切缘状态（27%R1）、淋巴结转移（35%N1）和主要 PM 与 OS 和 DSS 相关，P<0.01。主要 PM 是与 OS 和 DSS 降低相关的独立因素[危险比（HR）分别为 3.6 和 2.8，P<0.05]。主要 PM 患者的中位 DSS 为 14 个月，而经历轻微或无 PM 的患者的中位 DSS 为 40 个月，P<0.01。
HCCA 的广泛手术可能会产生大量的术后发病率。除了导致早期死亡率外，主要的术后并发症与 HCCA 切除术后癌症特异性生存时间的缩短有关。
