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[肝内胆管癌:84例切除术后的结果]

[Intrahepatic cholangiocarcinoma : Results after 84 resections].

作者信息

Neeff H P, Holzner P A, Menzel M, Bronsert P, Klock A, Lang S A, Fichtner-Feigl S, Hopt U T, Makowiec F

机构信息

Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetterstraße 55, 79106, Freiburg, Deutschland.

Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Breisacher Straße 115a, 79106, Freiburg, Deutschland.

出版信息

Chirurg. 2018 May;89(5):374-380. doi: 10.1007/s00104-018-0609-2.

Abstract

BACKGROUND

The incidence of intrahepatic cholangiocarcinoma (ICC) is increasing worldwide. Surgical resection is the only curative treatment option.

AIM OF THE STUDY

This study analyzed the prognostic factors after resection of ICC.

MATERIAL AND METHODS

A total of 84 patients were surgically treated under potentially curative intent. Perihilar and distal cholangiocarcinomas were excluded. The 5‑year survival was analyzed with respect to tumor stage (TNM), number of lesions, complete surgical resection (R0), peritoneal carcinosis and postoperative complications.

RESULTS

The 5‑year survival was 27% and 77% of patients underwent R0 resections. In the univariate analysis a T stage >2, an N+ situation or an R+ resection as well as peritoneal and multilocular intrahepatic spread were associated with a poorer prognosis. Postoperative complications also negatively influenced survival. On multivariate analysis the absence of peritoneal spread, node-negative tumor stages, singular hepatic lesions and a low T stage as well as the absence of complications were associated with improved survival.

DISCUSSION

The prognosis of ICC is poor even after successful surgical resection. Well-known tumor characteristics such as TNM are relevant prognostic factors. Surgical resection is accompanied by postoperative complications (most frequently biliary), which negatively influence survival. Adjuvant strategies are urgently needed to improve long-term survival even after complete surgical resection.

摘要

背景

肝内胆管癌(ICC)的发病率在全球范围内呈上升趋势。手术切除是唯一的根治性治疗选择。

研究目的

本研究分析了ICC切除术后的预后因素。

材料与方法

共有84例患者接受了潜在根治性手术治疗。肝门部和远端胆管癌被排除在外。根据肿瘤分期(TNM)、病灶数量、完整手术切除(R0)、腹膜转移癌和术后并发症分析5年生存率。

结果

5年生存率为27%,77%的患者接受了R0切除。单因素分析显示,T分期>2、N+情况或R+切除以及腹膜和肝内多房性扩散与预后较差相关。术后并发症也对生存产生负面影响。多因素分析显示,无腹膜扩散、淋巴结阴性肿瘤分期、单发肝内病灶、低T分期以及无并发症与生存率提高相关。

讨论

即使成功进行手术切除,ICC的预后仍然很差。TNM等众所周知的肿瘤特征是相关的预后因素。手术切除伴有术后并发症(最常见的是胆瘘),这对生存产生负面影响。即使在完全手术切除后,也迫切需要辅助治疗策略来提高长期生存率。

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