在N+病例中，当肝侧胆管切缘为阳性时，对于肝外胆管远端癌手术而言，术中无需额外切除胆管以使肝侧胆管切缘转为阴性。

When hepatic-side ductal margin is positive in N+ cases, additional resection of the bile duct is not necessary to render the negative hepatic-side ductal margin during surgery for extrahepatic distal bile duct carcinoma.

作者信息

Iso Yukihiro, Kita Junji, Kato Masato, Shimoda Mitsugi, Kubota Keiiehi

机构信息

Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.

出版信息

Med Sci Monit. 2014 Mar 22;20:471-5. doi: 10.12659/MSM.889714.

DOI:10.12659/MSM.889714

PMID:24657986

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3972054/

Abstract

BACKGROUND

The current standard treatment for extrahepatic distal bile duct carcinoma (EDBDC) is surgical resection, as no effective alternative treatment exists. In this study, we investigated the treatment strategies and outcomes for 90 cases of EDBDC at our department.

MATERIAL AND METHODS

Between April 2000 and March 2013, 90 pancreatoduodenectomies (PDs) were performed for EDBDC. The mean patient age was 69.1 ± 9.8 years, and there were 59 males and 31 females. Extended lymph adenectomy including lymph nodes around the common hepatic artery and celiac axis was performed in all patients. The mean operation time was 537.1 ± 153.8 min and the mean operative blood loss was 814.0 ± 494.0 ml. There were no operation-related deaths. The overall 1-, 3-, and 5-year survival rates were 90.0%, 51.2%, and 45.0%, respectively.

RESULTS

Lymph node metastasis was present in 28 patients (N+; 31.1%), and it was absent in 62 (N-; 68.9%). The 5-year survival rate was 20.0% for N+ patients and 52.4% for N- patients, which is significantly higher (P=0.03). Nine cases (10.0%) showed hepatic-side ductal margin (HM) positivity for carcinoma. The 5-year survival rate was 18.7% for HM-positive patients and 48.3% for HM-negative patients, which is significantly higher (P=0.005). In multivariate analysis, N+ was the strongest adverse prognostic factor. Subclass analysis of 62 cases (excluding 28 N+ cases) revealed 7 patients with positive HMs (11.3%) and 55 patients with negative HMs (88.7%). The 5-year survival rate was 47.6% for HM-positive patients and 49.8% for HM-negative patients (P=0.73). Thirty-five cases (38.9%) recurred: there were 19 cases of local recurrence (21.1%), 11 cases of liver metastasis (12.2%), 4 cases of distant recurrence (4.4%), and 1 case of para-aortic lymph node metastasis (1.1%).

CONCLUSIONS

In conclusion, when HM is positive in N+ cases, additional resection of the bile duct is not necessary to render the HM negative for carcinoma.

摘要

背景

肝外远端胆管癌（EDBDC）目前的标准治疗方法是手术切除，因为尚无有效的替代治疗方法。在本研究中，我们调查了我科90例EDBDC的治疗策略及结果。

材料与方法

2000年4月至2013年3月期间，对90例EDBDC患者实施了胰十二指肠切除术（PD）。患者平均年龄为69.1±9.8岁，男性59例，女性31例。所有患者均进行了扩大淋巴结清扫术，包括肝总动脉和腹腔干周围的淋巴结。平均手术时间为537.1±153.8分钟，平均术中失血量为814.0±494.0毫升。无手术相关死亡病例。1年、3年和5年总生存率分别为90.0%、51.2%和45.0%。

结果

28例患者出现淋巴结转移（N+；31.1%），62例未出现淋巴结转移（N-；68.9%）。N+患者的5年生存率为20.0%，N-患者为52.4%，差异有统计学意义（P=0.03）。9例（10.0%）患者的肝侧胆管切缘（HM）癌阳性。HM阳性患者的5年生存率为18.7%，HM阴性患者为48.3%，差异有统计学意义（P=0.005）。多因素分析显示，N+是最强的不良预后因素。对62例患者（不包括28例N+患者）进行亚组分析，发现7例HM阳性（11.3%），55例HM阴性（88.7%）。HM阳性患者的5年生存率为47.6%，HM阴性患者为49.8%（P=0.73）。35例（38.9%）出现复发：局部复发19例（21.1%），肝转移11例（12.2%），远处复发4例（4.4%），主动脉旁淋巴结转移1例（1.1%）。