Kim Wan-Joon, Hwang Shin, Lee Yong-Joo, Kim Ki-Hun, Park Kwang-Min, Ahn Chul-Soo, Moon Deok-Bog, Ha Tae-Yong, Song Gi-Won, Jung Dong-Hwan, Park Gil-Chun, Kim Myeong-Hwan, Lee Sung-Koo, Seo Dong Wan, Park Do Hyun, Lee Sang Soo, Lee Sung-Gyu
Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Ulsan, Seoul, South Korea.
J Gastrointest Surg. 2016 Jul;20(7):1368-75. doi: 10.1007/s11605-016-3103-5. Epub 2016 Feb 12.
We intended to investigate the clinicopathological features of intrahepatic intraductal papillary neoplasms of the bile duct (IPNB), especially their malignant features and post-resection prognosis. Forty-three patients who met the definition of IPNB and who underwent liver resection between January 2002 and June 2015 were selected from our institutional database of liver resection cases. The mean age was 63.3 ± 6.9 years and 24 were male. Hepatolithiasis was present in addition in 10 of the patients. Left- and right-sided hepatectomies and concurrent bile duct resection (BDR) were performed in 28, 15, and 10 patients, respectively; R0 resection was performed in 37 patients. The mean tumor diameter was 4.1 ± 2.2 cm. Histological tumor grade was low in 4 cases, intermediate in 6, and malignant in 33. There was no cancer-related recurrence or death in the 10 patients with low-grade or intermediate lesions. In the 33 patients with malignant lesions, rates of tumor recurrence and overall survival were 12.5 and 96.2 % at 1 year, 36.4 and 91.3 % at 3 years, and 47.0 and 68.8 % at 5 years, respectively. Multivariate analysis showed that R1 resection was the only prognostic factor for tumor recurrence and patient survival. BDR was performed in only 2 of 6 patients undergoing R1 resection. Intrahepatic IPNB is a rare type of biliary neoplasm that encompasses a histological spectrum ranging from benign disease to invasive malignancy. Long-term survival was anticipated after curative resection. R1 resection reduced survival outcomes; therefore, we suggest that concurrent BDR should be performed if the resection margin of the bile duct is not reliably free of neoplastic involvement.
我们旨在研究肝内胆管内乳头状肿瘤（IPNB）的临床病理特征，尤其是其恶性特征及切除术后的预后。从我们机构的肝切除病例数据库中选取了43例符合IPNB定义且在2002年1月至2015年6月期间接受肝切除的患者。平均年龄为63.3±6.9岁，男性24例。另外10例患者合并肝内胆管结石。分别有28例、15例和10例患者接受了左、右半肝切除术及同期胆管切除术（BDR）；37例患者实现了R0切除。平均肿瘤直径为4.1±2.2cm。组织学肿瘤分级：低级别4例，中级6例，恶性33例。10例低级别或中级病变患者无癌症相关复发或死亡。33例恶性病变患者中，1年时肿瘤复发率和总生存率分别为12.5%和96.2%，3年时为36.4%和91.3%，5年时为47.0%和68.8%。多因素分析显示，R1切除是肿瘤复发和患者生存的唯一预后因素。6例接受R1切除的患者中仅2例进行了BDR。肝内IPNB是一种罕见的胆管肿瘤，其组织学范围涵盖从良性疾病到浸润性恶性肿瘤。根治性切除后预期可长期生存。R1切除会降低生存结局；因此，我们建议，如果胆管切缘不能可靠地无肿瘤累及，应同期进行BDR。
