Division of HPB and Liver Transplantation, Department of Surgery, University Surgical Cluster, National University Health System, Singapore , Singapore.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Republic of Korea.
World J Surg. 2012 May;36(5):1112-1121. doi: 10.1007/s00268-012-1497-0.
Concomitant liver resection for type III hilar cholangiocarcinoma could improve the R0 resection rate and long-term outcome. In the present study, we examine the specific role of caudate lobectomy in liver resection for type III(A) and III(B) hilar cholangiocarcinoma and the prognostic factors for survival in this group of patients.
We reviewed all patients with type III(A) and III(B) hilar cholangiocarcinoma who underwent liver resection in Samsung Medical Center from January 1995 to July 2010. Patients were divided into those with and without caudate lobectomy (CL). The log rank test and Cox regression analysis were employed to investigate for prognostic factors of survival.
There were 127 patients in this cohort, 57 without CL (44.9%) and 70 with CL (55.1%). The demographics and symptoms of presentation were comparable. The median preoperative bilirubin level was significantly higher in the group undergoing CL (p = 0.017). Patients with CL had a significantly better overall survival (OS) (CL: 64.0 months vs without CL: 34.6 months) (p = 0.010) and disease-free survival (DFS) (CL: 40.5 months vs without CL: 27.0 months) (p = 0.031). Multivariate analysis showed that presence of symptoms (p = 0.025) and positive lymph node (LN) metastasis (p < 0.001) were negative prognostic factors for OS. Furthermore, multivariate analysis for DFS found that caudate lobectomy (p = 0.016) and positive LN metastasis (p = 0.001) were positive and negative prognostic factors, respectively.
Caudate lobectomy contributed to improvement of DFS and OS in type III hilar cholangiocarcinoma. Other prognostic factors include positive LN metastasis and presence of symptoms.
对于 III 型肝门部胆管癌，同时进行肝切除术可提高 R0 切除率和长期疗效。本研究旨在探讨尾状叶切除术在 III(A)和 III(B)型肝门部胆管癌肝切除中的具体作用，以及该组患者的生存预后因素。
我们回顾了 1995 年 1 月至 2010 年 7 月在三星医疗中心接受 III(A)和 III(B)型肝门部胆管癌肝切除术的所有患者。将患者分为行尾状叶切除术（CL）组和未行尾状叶切除术（无 CL）组。采用对数秩检验和 Cox 回归分析探讨生存的预后因素。
本队列共纳入 127 例患者，57 例未行 CL（44.9%），70 例行 CL（55.1%）。两组患者的人口统计学和临床表现无差异。行 CL 组的术前中位胆红素水平显著升高（p = 0.017）。CL 组的总生存（OS）（CL：64.0 个月 vs 无 CL：34.6 个月）（p = 0.010）和无病生存（DFS）（CL：40.5 个月 vs 无 CL：27.0 个月）（p = 0.031）均显著改善。多变量分析显示，有症状（p = 0.025）和阳性淋巴结（LN）转移（p < 0.001）是 OS 的负预后因素。此外，DFS 的多变量分析发现，尾状叶切除术（p = 0.016）和阳性 LN 转移（p = 0.001）分别是正和负预后因素。
尾状叶切除术可改善 III 型肝门部胆管癌的 DFS 和 OS。其他预后因素包括阳性 LN 转移和有症状。
