Nakanishi Yoshitsugu, Tsuchikawa Takahiro, Okamura Keisuke, Nakamura Toru, Tamoto Eiji, Murakami Soichi, Ebihara Yuma, Kurashima Yo, Noji Takehiro, Asano Toshimichi, Shichinohe Toshiaki, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Surgery. 2016 Jun;159(6):1511-1519. doi: 10.1016/j.surg.2016.01.012. Epub 2016 Mar 3.
The aim of this study was to determine the impact of the site of portal vein invasion on survival after hepatectomy for perihilar cholangiocarcinoma.
This study classified 168 patients undergoing resection for perihilar cholangiocarcinoma histologically as without portal vein resection or tumor invasion to the portal vein (PV0), with tumor invasion to unilateral branches of the portal vein (PVt3), or with tumor invasion to the main portal vein or its bilateral branches, or to unilateral second-order biliary radicals with contralateral portal vein involvement (PVt4). Patients in PVt4 were subclassified into the A-M group (cancer invasion limited to the tunica adventitia or media) or the I group (cancer invasion reaching the tunica intima).
Of the patients, 121 were in PV0, 21 were in PVt3, and 26 were in PVt4. There was no difference in survival between the PV0 and PVt3 groups (P = .267). The PVt4 group had a worse prognosis than the PVt3 group (P = .046). In addition, the A-M (n = 19) and I subgroups (n = 7) of PVt4 had worse prognoses than the PV0 or PVt3 groups (P = .005 and < .001, respectively). All patients in the I subgroup of PVt4 died within 9 months after resection. On multivariate analysis, PVt4 (P = .029) was identified as an independent prognostic factor.
In perihilar cholangiocarcinoma, postoperative survival was no different between patients with and without ipsilateral portal vein invasion, although patients with tumor invasion to the main or contralateral branches of the portal vein, especially with tunica intima invasion, had extremely poor prognoses.
本研究旨在确定门静脉侵犯部位对肝门部胆管癌肝切除术后生存的影响。
本研究将168例行肝门部胆管癌切除术的患者按组织学分类为未行门静脉切除或肿瘤未侵犯门静脉（PV0）、肿瘤侵犯门静脉单侧分支（PVt3）、肿瘤侵犯门静脉主干或其双侧分支或侵犯单侧二级胆管分支且对侧门静脉受累（PVt4）。PVt4组患者又分为A-M组（癌侵犯限于外膜或中膜）或I组（癌侵犯达内膜）。
患者中，121例属于PV0组，21例属于PVt3组，26例属于PVt4组。PV0组和PVt3组的生存率无差异（P = 0.267）。PVt4组的预后比PVt3组差（P = 0.046）。此外，PVt4组的A-M亚组（n = 19）和I亚组（n = 7）的预后比PV0组或PVt3组差（分别为P = 0.005和<0.001）。PVt4组I亚组的所有患者在切除术后9个月内死亡。多因素分析显示，PVt4（P = 0.029）被确定为独立预后因素。
在肝门部胆管癌中，同侧门静脉侵犯与否的患者术后生存率无差异，尽管肿瘤侵犯门静脉主干或对侧分支，尤其是侵犯内膜的患者预后极差。
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