Regimbeau Jean Marc, Fuks David, Pessaux Patrick, Bachellier Philippe, Chatelain Denis, Diouf Momar, Raventos Artigas, Mantion Georges, Gigot Jean-Francois, Chiche Laurence, Pascal Gerard, Azoulay Daniel, Laurent Alexis, Letoublon Christian, Boleslawski Emmanuel, Rivoire Michel, Mabrut Jean-Yves, Adham Mustapha, Le Treut Yves-Patrice, Delpero Jean-Robert, Navarro Francis, Ayav Ahmet, Boudjema Karim, Nuzzo Gennaro, Scotte Michel, Farges Olivier
Department of Digestive and Metabolic Surgery, Amiens University Medical Center, Amiens, France.
HPB (Oxford). 2015 Jan;17(1):79-86. doi: 10.1111/hpb.12296. Epub 2014 Jul 3.
As mortality and morbidity after a curative resection remains high, it is essential to identify pre-operative factors associated with an early death after a major resection.
Between 1998 and 2008, we selected a population of 331 patients having undergone a major hepatectomy including segment I with a lymphadenectomy and a common bile duct resection for a proven hilar cholangiocarcinoma in 21 tertiary centres. The study's objective was to identify pre-operative predictors of early death (<12 months) after a resection.
The study cohort consisted of 221 men and 110 women, with a median age of 61 years (range: 24-85). The post-operative mortality and morbidity rates were 8.2% and 61%, respectively. The 1-, 3- and 5-year overall survival rates were 85%, 64% and 53%, respectively. The median tumour size was 23 mm on pathology, ranging from 8 to 40. A tumour size >30 mm [odds ratio (OR) 2.471 (95% confidence interval (CI) 1.136-7.339), P = 0.001] and major post-operative complication [OR 3.369 (95% CI 1.038-10.938), P = 0.004] were independently associated with death <12 months in a multivariate analysis.
The present analysis of a series of 331 patients with hilar cholangiocarcinoma showed that tumour size >30 mm was independently associated with death <12 months.
由于根治性切除术后的死亡率和发病率仍然很高，因此确定与大手术切除后早期死亡相关的术前因素至关重要。
1998年至2008年间，我们在21个三级中心选取了331例行大肝切除术（包括Ⅰ段切除、淋巴结清扫及胆总管切除）的患者，这些患者均经证实患有肝门部胆管癌。本研究的目的是确定切除术后早期死亡（<12个月）的术前预测因素。
研究队列包括221名男性和110名女性，中位年龄为61岁（范围：24 - 85岁）。术后死亡率和发病率分别为8.2%和61%。1年、3年和5年总生存率分别为85%、64%和53%。病理检查显示肿瘤大小中位数为23毫米，范围为8至40毫米。在多变量分析中，肿瘤大小>30毫米[比值比（OR）2.471（95%置信区间（CI）1.136 - 7.339），P = 0.001]和术后严重并发症[OR 3.369（95%CI 1.038 - 10.938），P = 0.004]与12个月内死亡独立相关。
对331例肝门部胆管癌患者的本次分析表明，肿瘤大小>30毫米与12个月内死亡独立相关。
