针对Bismuth I型和II型肝门部胆管癌的扩大肝切除术

Major hepatectomy in Bismuth types I and II hilar cholangiocarcinoma.

作者信息

Xiong Junjie, Nunes Quentin M, Huang Wei, Wei Ailin, Ke Nengwen, Mai Gang, Liu Xubao, Hu Weiming

机构信息

Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.

NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.

出版信息

J Surg Res. 2015 Mar;194(1):194-201. doi: 10.1016/j.jss.2014.10.029. Epub 2014 Oct 22.

DOI:10.1016/j.jss.2014.10.029

PMID:25454973

Abstract

BACKGROUND

Historically, hilar bile duct resection (HBDR) has been regarded as the choice of treatment for Bismuth types I and II hilar cholangiocarcinoma (HCCA). The present study aimed to evaluate the advantages of major liver resection (MLR) in the treatment of patients with Bismuth types I and II HCCA when compared with HBDR.

MATERIALS AND METHODS

Between January 2005 and September 2012, in total, 52 patients with Bismuth types I and II HCCA who underwent HBDR alone or MLR were included for retrospective analysis. The intraoperative outcomes, postoperative complications, and oncological outcomes including recurrence and overall or disease-free survival rate were compared.

RESULTS

The MLR group had significantly higher curative resection rates compared with the HBDR group (95% versus 62.5%, P = 0.021) and lower tumor recurrence (28% versus 63%, P = 0.049), albeit with longer operating time (395.5 ± 112.7 versus 270.9 ± 98.8, P < 0.001), and higher blood transfusion requirements (70% versus 16%, P < 0.001). MLR resulted in significantly higher overall postoperative morbidity (70% versus 34.4%, P = 0.012), compared with HBDR alone. When restricted to R0 resections for all the procedures, MLR significantly increased the overall postoperative survival rate compared with the HBDR group (P = 0.016); the overall survival rate at 1, 3 y was 68.4% and 60.8% for MLR group and 59.6% and 21.9% for HBDR group, respectively. Also, the disease-free survival rate was significantly higher in patients who underwent MLR, as compared with those who underwent HBDR (53.2% versus 0% at 3 y, P = 0.005).

CONCLUSIONS

Our study has shown that MLR results in higher curative resections, fewer recurrences, and increased postoperative survival rate for Bismuth types I and II HCCA as compared with HBDR alone. However, there is a need for well-designed, multicenter studies to be undertaken to better inform a decision on the standard treatment for Bismuth types I and II HCCA.

摘要

背景

从历史上看，肝门部胆管切除术（HBDR）一直被视为治疗Bismuth I型和II型肝门部胆管癌（HCCA）的首选治疗方法。本研究旨在评估与HBDR相比，扩大肝切除术（MLR）在治疗Bismuth I型和II型HCCA患者中的优势。

材料与方法

2005年1月至2012年9月期间，共有52例单独接受HBDR或MLR的Bismuth I型和II型HCCA患者纳入回顾性分析。比较术中结果、术后并发症以及包括复发、总生存率或无病生存率在内的肿瘤学结果。

结果

与HBDR组相比，MLR组的根治性切除率显著更高（95%对62.5%，P = 0.021），肿瘤复发率更低（28%对63%，P = 0.049），尽管手术时间更长（395.5±112.7对270.9±98.8，P < 0.001），输血需求更高（70%对16%，P < 0.001）。与单独的HBDR相比，MLR导致术后总体发病率显著更高（70%对34.4%，P = 0.012）。当所有手术均为R0切除时，与HBDR组相比，MLR显著提高了术后总体生存率（P = 0.016）；MLR组1年、3年的总生存率分别为68.4%和60.8%，HBDR组分别为59.6%和21.9%。此外，与接受HBDR的患者相比，接受MLR的患者无病生存率显著更高（3年时为53.2%对0%，P = 0.005）。