Lee Jae Hoon, Hwang Dae Wook, Lee Sang Yeup, Park Kwang-Min, Lee Young-Joo
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea.
Am Surg. 2012 Apr;78(4):471-7.
Achieving an R0 resection can be difficult for hilar cholangiocarcinoma (HC) because of the anatomic structures of the hepatic hilum and frequent tumor infiltration. The aim of this study was to evaluate the margin status of bile duct resected in HC and prognostic impact of R1 resection. Between 2000 and 2009, 245 patients underwent operation for HC at Asan Medical Center. We retrospectively analyzed the clinicopathologic features and surgical outcomes, focusing on the proximal margin status, of 162 cases of patients with curative intention. Curative resections were achieved in 125 (52.1%) patients, and R1 resections were performed in 43 (26.5%). Proximal ductal margin states were classified as free margin (73.5%), carcinoma in situ (3.7%), and invasive carcinoma (22.8%). The 3- and 5-year survival rates of the R1 group (39.5% and 34.9%) were not significantly different from the rates of the R0 group (55.5% and 44.5%, respectively). Multivariate analysis showed lymph node metastasis (P = 0.001) and histologic differentiation (P = 0.001) were independent predictors of patient survival. The aggressive surgical approach based on liver resection including caudate lobe may increase the number of patients eligible for a curative chance and improve long-term survival even if the microscopically positive margin is still achieved.
由于肝门部的解剖结构以及肿瘤频繁浸润，肝门部胆管癌（HC）实现R0切除可能具有挑战性。本研究的目的是评估HC手术切除胆管的切缘状态以及R1切除对预后的影响。2000年至2009年期间，245例患者在峨山医学中心接受了HC手术。我们回顾性分析了162例有治愈意向患者的临床病理特征和手术结果，重点关注近端切缘状态。125例（52.1%）患者实现了根治性切除，43例（26.5%）患者进行了R1切除。近端胆管切缘状态分为切缘阴性（73.5%）、原位癌（3.7%）和浸润癌（22.8%）。R1组的3年和5年生存率（分别为39.5%和34.9%）与R0组（分别为55.5%和44.5%）相比，差异无统计学意义。多因素分析显示，淋巴结转移（P = 0.001）和组织学分化（P = 0.001）是患者生存的独立预测因素。基于包括尾状叶在内的肝切除的积极手术方法可能会增加有治愈机会的患者数量，并改善长期生存，即使仍实现显微镜下切缘阳性。
