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根治性手术后肝内胆管癌患者术后并发症的预后影响

Prognostic impacts of postoperative complications in patients with intrahepatic cholangiocarcinoma after curative operations.

作者信息

Miyata Tatsunori, Yamashita Yo-Ichi, Yamao Takanobu, Umezaki Naoki, Tsukamoto Masayo, Kitano Yuki, Yamamura Kensuke, Arima Kota, Kaida Takayoshi, Nakagawa Shigeki, Imai Katsunori, Hashimoto Daisuke, Chikamoto Akira, Ishiko Takatoshi, Baba Hideo

机构信息

Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-0811, Japan.

出版信息

Int J Clin Oncol. 2017 Jun;22(3):526-532. doi: 10.1007/s10147-017-1099-9. Epub 2017 Feb 15.

Abstract

BACKGROUND

The postoperative complication is one of an indicator of poor prognosis in patients with several gastroenterological cancers after curative operations. We, herein, examined prognostic impacts of postoperative complications in patients with intrahepatic cholangiocarcinoma after curative operations.

METHODS

We retrospectively analyzed 60 patients with intrahepatic cholangiocarcinoma who underwent primary curative operations from June 2002 to February 2016. Prognostic impacts of postoperative complications were analyzed using log-rank test and Cox proportional hazard model.

RESULTS

Postoperative complications (Clavien-Dindo classification grade 3 or more) occurred in 13 patients (21.7%). Overall survival of patients without postoperative complications was significantly better than that of patients with postoperative complications (p = 0.025). Postoperative complications are independent prognostic factor of overall survival (hazard ratio 3.02; p = 0.030). In addition, bile duct resection and reconstruction (Odds ratio 59.1; p = 0.002) and hepatitis C virus antibody positive (Odds ratio 7.14; p= 0.022), and lymph node dissection (Odds ratio 6.28; p = 0.040) were independent predictors of postoperative complications.

CONCLUSION

Postoperative complications may be an independent predictor of poorer survival in patients with intrahepatic cholangiocarcinoma after curative operations. Lymph node dissection and bile duct resection and reconstruction were risk factors for postoperative complications, therefore we should pay attentions to perform lymph node dissections, bile duct resection and reconstruction in patients with intrahepatic cholangiocarcinoma.

摘要

背景

术后并发症是几种胃肠癌患者根治性手术后预后不良的指标之一。在此,我们研究了根治性手术后肝内胆管癌患者术后并发症的预后影响。

方法

我们回顾性分析了2002年6月至2016年2月期间接受初次根治性手术的60例肝内胆管癌患者。使用对数秩检验和Cox比例风险模型分析术后并发症的预后影响。

结果

13例患者(21.7%)发生了术后并发症(Clavien-Dindo分类3级及以上)。无术后并发症患者的总生存期明显优于有术后并发症的患者(p = 0.025)。术后并发症是总生存期的独立预后因素(风险比3.02;p = 0.030)。此外,胆管切除与重建(比值比59.1;p = 0.002)、丙型肝炎病毒抗体阳性(比值比7.14;p = 0.022)以及淋巴结清扫(比值比6.28;p = 0.040)是术后并发症的独立预测因素。

结论

术后并发症可能是根治性手术后肝内胆管癌患者生存较差的独立预测因素。淋巴结清扫以及胆管切除与重建是术后并发症的危险因素,因此我们在肝内胆管癌患者进行淋巴结清扫、胆管切除与重建时应予以关注。

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