Kim Naru, Lee Huisong, Min Seog Ki, Lee Hyeon Kook
Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2018 May;94(5):240-246. doi: 10.4174/astr.2018.94.5.240. Epub 2018 Apr 30.
To compare survival outcomes between bile duct segmental resection (BDR) and pancreatoduodenectomy (PD) for the treatment of middle and distal bile duct cancer.
From 1997 to 2013, a total of 96 patients who underwent curative intent surgery for middle and distal bile duct cancer were identified. The patients were divided into 2 groups based on the type of operation; 20 patients were included in the BDR group and 76 patients were in the PD group. We retrospectively reviewed the clinical outcomes.
The number of lymph nodes (LNs) was significantly greater in patients within the PD group compared to the BDR group. The total number of LNs was 6.5 ± 8.2 . 11.2 ± 8.2 (P = 0.017) and the number of metastatic LNs was 0.4 ± 0.9 . 1.0 ± 1.5 (P = 0.021), respectively. After a median follow-up period of 24 months (range, 4-169 months), the recurrence-free survival of the PD group was superior to that of the BDR group (P = 0.035). In the patients with LN metastases, the patients undergoing PD had significantly better survival than the BDR group (P < 0.001).
Surgeons should be cautious in deciding to perform BDR for middle and distal common bile duct cancer. PD is recommended if LN metastases are suspected.
比较胆管节段性切除术（BDR）和胰十二指肠切除术（PD）治疗中、远端胆管癌的生存结果。
1997年至2013年，共确定96例接受中、远端胆管癌根治性手术的患者。根据手术类型将患者分为两组；BDR组纳入20例患者，PD组纳入76例患者。我们回顾性分析了临床结果。
PD组患者的淋巴结（LNs）数量显著多于BDR组。LNs总数分别为6.5±8.2、11.2±8.2（P = 0.017），转移LNs数量分别为0.4±0.9、1.0±1.5（P = 0.021）。中位随访期24个月（范围4 - 169个月）后，PD组的无复发生存率优于BDR组（P = 0.035）。在有LN转移的患者中，接受PD手术的患者生存情况明显优于BDR组（P < 0.001）。
外科医生在决定对中、远端胆总管癌进行BDR时应谨慎。如果怀疑有LN转移，建议行PD手术。
