肝内胆管癌扩大肝切除术：是福是祸？

Extended liver resections for intrahepatic cholangiocarcinoma: friend or foe?

作者信息

Bergeat Damien, Sulpice Laurent, Rayar Michel, Edeline Julien, Merdignac Aude, Meunier Bernard, Boucher Eveline, Boudjema Karim

机构信息

Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, Rennes, France; INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France.

出版信息

Surgery. 2015 Apr;157(4):656-65. doi: 10.1016/j.surg.2014.11.011. Epub 2015 Feb 20.

DOI:10.1016/j.surg.2014.11.011

PMID:25704428

Abstract

BACKGROUND

In patients with intrahepatic cholangiocarcinoma (ICC), extended liver resections (ELRs) increase the rate of resectability. The aims of the present study were to evaluate the morbidity and oncologic outcomes of ELR compared with other liver resections (LR) for ICC.

METHODS

All LR for ICC that were performed in our center between January 1997 and September 2013 and conducted with curative intent were included in this retrospective analysis. ELRs were defined by resections of ≥5 liver segments. The factors that influenced the occurrence of major complications (Clavien ≥ 3) and overall survival (OS) were tested with univariate and multivariate analyses.

RESULTS

One hundred seven patients (82 men and 25 women) were resected, and 27 (25.3%) underwent ELRs. Compared with the LRs, the ELRs were performed in larger tumors (P = .003) and were significantly associated with more complex surgeries such as vascular (P < .001) or biliary reconstructions (P < .001). Multivariate analysis revealed that ELR was an independent risk factor for major complications (odds ratio [OR], 6.2; 95% CI, 2.11-19.62; P < .001). Compared with the other LRs, ELRs had no effects on OS or disease-free survival (P = .881 and P = .228, respectively). Perioperative blood transfusion (Hazard ratio (HR), 2.51; 95% CI, 1.49-4.23; P < .001), the presence of >1 nodule (HR, 3.17; 95% CI, 1.67-5.97; P < .001), and age ≥65 years (HR, 1.72; 95% CI, 1.03-2.86; P = .036) were independent prognostic factors for OS.

CONCLUSION

This study suggests that ELRs performed for large ICCs do not affect negatively oncologic outcomes, despite the increased risk of major complications.

摘要

背景

在肝内胆管癌（ICC）患者中，扩大肝切除术（ELR）可提高切除率。本研究的目的是评估与其他用于ICC的肝切除术（LR）相比，ELR的发病率和肿瘤学结局。

方法

本回顾性分析纳入了1997年1月至2013年9月在本中心进行的、具有治愈意图的所有用于ICC的LR。ELR定义为切除≥5个肝段。通过单因素和多因素分析来检验影响主要并发症（Clavien≥3级）发生和总生存期（OS）的因素。

结果

共107例患者（82例男性和25例女性）接受了手术切除，其中27例（25.3%）接受了ELR。与LR相比，ELR用于更大的肿瘤（P = 0.003），并且与更复杂的手术显著相关，如血管重建（P < 0.001）或胆管重建（P < 0.001）。多因素分析显示，ELR是主要并发症的独立危险因素（比值比[OR]，6.2；95%可信区间[CI]，2.11 - 19.62；P < 0.001）。与其他LR相比，ELR对OS或无病生存期无影响（分别为P = 0.881和P = 0.228）。围手术期输血（风险比[HR]，2.51；95%CI，1.49 - 4.23；P < 0.001）、存在>1个结节（HR，3.17；95%CI，1.67 - 5.97；P < 0.001）和年龄≥65岁（HR，1.72；95%CI，1.03 - 2.86；P = 0.036）是OS的独立预后因素。