Fukami Yasuyuki, Kaneoka Yuji, Maeda Atsuyuki, Takayama Yuichi, Onoe Shunsuke
Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
Langenbecks Arch Surg. 2016 Jun;401(4):471-8. doi: 10.1007/s00423-016-1413-4. Epub 2016 Mar 29.
Major hepatopancreatoduodenectomy (HPD) with simultaneous resection of the hepatic artery (HA) for biliary cancer is the most extended surgery for obtaining curative resection, and its clinical significance is unclear. The aim of this study was to appraise the clinical value of this extended procedure as a treatment for biliary cancer.
We retrospectively reviewed the medical records of 38 patients with biliary cancer who underwent major HPD from 1994 to 2014. Clinicopathological factors and survival following HPD were compared between patients with and without simultaneous resection of the HA.
Of the 38 study patients, 12 patients (32 %) underwent major HPD with HA. There was no significant difference in major complications between the two groups. The overall 2-year survival rate and the median survival time following major HPD with HA were 71 % and 42.3 months. The survival of the patients with gallbladder cancer was significantly worse than that of the patients with bile duct cancer (p = 0.001).
Major HPD with simultaneous resection of the HA can be a preferable treatment option for bile duct cancer that offers acceptable perioperative morbidity and mortality, as well as long-term survival. However, this procedure for gallbladder cancer should not be performed.
对于胆管癌，同时切除肝动脉（HA）的扩大根治性肝胰十二指肠切除术（HPD）是实现根治性切除的最广泛手术方式，但其临床意义尚不清楚。本研究旨在评估这种扩大手术作为胆管癌治疗方法的临床价值。
我们回顾性分析了1994年至2014年间38例行扩大根治性HPD的胆管癌患者的病历。比较了同时切除HA和未切除HA患者的临床病理因素及HPD后的生存率。
38例研究患者中，12例（32%）行扩大根治性HPD并切除HA。两组主要并发症无显著差异。扩大根治性HPD并切除HA后的总体2年生存率和中位生存时间分别为71%和42.3个月。胆囊癌患者的生存率显著低于胆管癌患者（p = 0.001）。
同时切除HA的扩大根治性HPD对于胆管癌可能是一种较好的治疗选择，其围手术期发病率和死亡率可接受，且能实现长期生存。然而，不应将此手术用于胆囊癌。
