Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
J Gastrointest Surg. 2017 Nov;21(11):1841-1850. doi: 10.1007/s11605-017-3499-6. Epub 2017 Jul 25.
The objective of the current study was to investigate both short- and long-term outcomes of patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) stratified by extent of hepatic resection relative to overall final pathological margin status.
One thousand twenty-three patients with ICC who underwent curative-intent resection were identified from a multi-institutional database. Demographic, clinicopathological, and operative data, as well as overall (OS) and recurrence-free survival (RFS) were compared among patients undergoing major and minor resection before and after propensity score matching.
Overall, 608 (59.4%) patients underwent major hepatectomy, while 415 (40.6%) had a minor resection. Major hepatectomy was more frequently performed among patients who had large, multiple, and bilobar tumors. Roughly half of patients (n = 294, 48.4%) developed a postoperative complication following major hepatectomy versus only one fourth of patients (n = 113, 27.2%) after minor resection (p < 0.001). In the propensity model, patients who underwent major hepatectomy had an equivalent OS and RFS versus patients who had a minor hepatectomy (median OS, 38 vs. 37 months, p = 0.556; and median RFS, 20 vs. 18 months, p = 0.635). Patients undergoing major resection had comparable OS and RFS with wide surgical margin (≥10 and 5-9 mm), but improved RFS when surgical margin was narrow (1-4 mm) versus minor resection in the propensity model. In the Cox regression model, tumor characteristics and surgical margin were independently associated with long-term outcome.
Major hepatectomy for ICC was not associated with an overall survival benefit, yet was associated with increased perioperative morbidity. Margin width, rather than the extent of resection, affected long-term outcomes. Radical parenchymal-sparing resection should be advocated if a margin clearance of ≥5 mm can be achieved.
本研究旨在探讨根据肝切除范围相对于最终病理切缘状态，对接受根治性切除术的肝内胆管细胞癌（ICC）患者进行分层的短期和长期结果。
从多机构数据库中确定了 1023 名接受根治性切除术的 ICC 患者。比较了倾向评分匹配前后行大、小切除术的患者的人口统计学、临床病理学和手术数据以及总生存期（OS）和无复发生存期（RFS）。
总体而言，608 例（59.4%）患者行大肝切除术，415 例（40.6%）行小肝切除术。大肝切除术更多地用于大、多、双侧肿瘤患者。大肝切除术后约有一半患者（n=294，48.4%）发生术后并发症，而小肝切除术后仅有四分之一患者（n=113，27.2%）发生术后并发症（p<0.001）。在倾向模型中，与小肝切除术相比，行大肝切除术的患者的 OS 和 RFS 相当（中位 OS，38 个月 vs. 37 个月，p=0.556；中位 RFS，20 个月 vs. 18 个月，p=0.635）。在倾向模型中，大肝切除术患者的 OS 和 RFS 与广泛手术切缘（≥10 和 5-9mm）相当，但手术切缘狭窄（1-4mm）时 RFS 优于小肝切除术。在 Cox 回归模型中，肿瘤特征和手术切缘与长期结果独立相关。
ICC 大肝切除术与总生存获益无关，但与围手术期发病率增加有关。切缘宽度而不是切除范围影响长期结果。如果能够实现 5mm 以上的切缘清除，则应提倡激进的保肝叶切除术。
