左三叶切除术和右半肝切除术治疗肝门部胆管癌的结果。

Outcomes of left trisectionectomy and right hepatectomy for perihilar cholangiocarcinoma.

机构信息

Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.

Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.

出版信息

HPB (Oxford). 2019 Apr;21(4):489-498. doi: 10.1016/j.hpb.2018.08.017. Epub 2018 Oct 2.

DOI:10.1016/j.hpb.2018.08.017

PMID:30290984

Abstract

BACKGROUND

Right hepatectomy (RH) is the standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. Therefore, this study aimed to compare the outcomes of LT and RH for PHC.

METHODS

Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching.

RESULTS

Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (37%) underwent LT, and 70 (63%) underwent RH. In a matched cohort (LT: n = 27, RH: n = 27), major complication rates (67% vs. 52%; p = 0.42), 90-day mortality rates (15% vs. 0%; p = 0.11) and R0 resection rates (56% vs. 44%; p = 0.58) were similar in both groups. The 3-year recurrence-free survival rates (27% vs. 47%; p = 0.27) and overall survival rates (45% vs. 60%; p = 0.17) were also similar in both groups.

CONCLUSIONS

In patients with PHC, LT could achieve similar surgical and survival outcomes as RH.

摘要

背景

右半肝切除术（RH）是许多中心治疗肝门部胆管癌（PHC）右侧优势型的标准手术方法。虽然在高容量中心，左三叶切除术（LT）被积极用于治疗左侧优势型 PHC，但 LT 的手术和生存结果尚不清楚。因此，本研究旨在比较 LT 和 RH 治疗 PHC 的结果。

方法

回顾性分析 2008 年至 2016 年在千叶大学医院接受手术切除治疗的连续 PHC 患者。比较了接受 LT 和 RH 治疗的 PHC 患者的结果，并进行了一对一倾向评分匹配。

结果

在连续 171 例 PHC 切除患者中，有 111 例符合研究条件；41 例（37%）接受 LT，70 例（63%）接受 RH。在匹配队列（LT：n=27，RH：n=27）中，主要并发症发生率（67% vs. 52%；p=0.42）、90 天死亡率（15% vs. 0%；p=0.11）和 R0 切除率（56% vs. 44%；p=0.58）在两组之间相似。3 年无复发生存率（27% vs. 47%；p=0.27）和总生存率（45% vs. 60%；p=0.17）在两组之间也相似。