Division of Transplantation, Department of Surgery, University of Louisville, Louisville, KY, USA.
HPB (Oxford). 2012 Feb;14(2):142-9. doi: 10.1111/j.1477-2574.2011.00419.x. Epub 2011 Dec 12.
In hilar cholangiocarcinoma, resection provides the only opportunity for longterm survival. A US experience of hilar cholangiocarcinoma was examined to determine the effect of clinical experience on negative margin (R0) resection rates.
We conducted a retrospective analysis of 110 consecutive hilar cholangiocarcinoma patients presenting over an 18-year period. Analyses were performed using chi-squared, Wilcoxon rank sum and Kaplan-Meier methods, and multivariable Cox and logistic regression modelling.
Of the 110 patients in the cohort, 59.1% were male and 90.9% were White. The median patient age was 64 years. A total of 59 (53.6%) patients underwent resection; 37 of these demonstrated R0. The 30-day mortality rate was 5.1%; the complication rate was 39.0%. The rate of resectability increased over time (36.4% vs. 70.9%; P= 0.001), as did the percentage of R0 resections (10.9% vs. 56.5%; P < 0.001). Of the 59 patients who underwent resection, 23 (39.0%) experienced recurrence. Multivariable Cox regression analysis identified resection margins [hazard ratio (HR) = 4.124 for positive vs. negative; P= 0.002] and type of operation (HR = 5.075 for exploration vs. resection; P= 0.001) as significant to survival.
Although R0 resection can be achieved in only a minority of patients, these patients have a reasonable chance of longterm survival. The last decade has seen a significant rise in rates of resectability of Klatskin's tumour at specialty centres.
在肝门部胆管癌中，切除是获得长期生存的唯一机会。本文分析了美国肝门部胆管癌的治疗经验，以明确临床经验对切缘阴性（R0）切除率的影响。
我们对 18 年间收治的 110 例肝门部胆管癌患者进行回顾性分析。采用卡方检验、Wilcoxon 秩和检验和 Kaplan-Meier 方法以及多变量 Cox 和逻辑回归模型进行分析。
该队列中 110 例患者中，59.1%为男性，90.9%为白人。中位患者年龄为 64 岁。共 59 例患者接受了手术切除，其中 37 例为 R0 切除。30 天死亡率为 5.1%，并发症发生率为 39.0%。可切除性的比例随时间增加而增加（36.4% vs. 70.9%，P=0.001），R0 切除率也随之增加（10.9% vs. 56.5%，P<0.001）。59 例行切除术的患者中，23 例（39.0%）复发。多变量 Cox 回归分析显示，切除边缘（阳性 vs. 阴性，HR=4.124，P=0.002）和手术方式（探查术 vs. 切除术，HR=5.075，P=0.001）与生存显著相关。
尽管只有少数患者能够达到 R0 切除，但这些患者仍有获得长期生存的合理机会。在专业中心，近 10 年来 Klatskin 肿瘤的可切除率显著提高。
