中段胆管癌的治疗：局部切除术还是胰十二指肠切除术？

Treatment of mid-bile duct carcinoma: Local resection or pancreatoduodenectomy?

机构信息

Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.

Department of pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.

出版信息

Eur J Surg Oncol. 2019 Nov;45(11):2180-2187. doi: 10.1016/j.ejso.2019.06.032. Epub 2019 Jun 29.

DOI:10.1016/j.ejso.2019.06.032

PMID:31279596

Abstract

INTRODUCTION

Whereas distal cholangiocarcinoma (DC) is treated by pancreatoduodenectomy (PD), consensus is lacking on treatment of mid-bile duct carcinoma (mid-BDC) without involvement of the pancreatic head. Both PD or a local resection (LR) of the extrahepatic bile duct with lymphadenectomy are being used. The aim of this study was to compare outcomes after PD and LR for mid-BDC and, for reference, PD for DC.

METHODS

Retrospective monocenter study including consecutive patients who underwent LR for mid-BDC (LR), PD for mid-BDC (PD-mid) and PD for DC (PD-distal) between 2000 and 2016. Clinicopathologic characteristics, postoperative outcomes and survival were compared.

RESULTS

A total of 184 patients were included (LR, 22; PD-mid, 38; PD-distal, 124). Postoperative mortality was 0% following LR, 5% (2/22) for PD-mid and 3% (4/124) for PD-distal, p = 0.542. Major complications occurred in 5/22 patients (23%), 19/39 (50%) and 46/124 (37%) respectively, p = 0.103 (LR versus PD-mid, p = 0.038). Tumor size, differentiation grade and resection margin status were comparable across groups. Median number of resected lymph nodes was 5 (range 3-7), 9 (7-14) and 12 (8-16) respectively, p < 0.001. Median overall survival was 46 months (95%CI 10-82), 19 months. (95%CI 11-27), and 29 months (95%CI 23-35) respectively, p = 0.39 (LR versus PD-mid, p = 0.20). Disease-free survival also did not differ.

CONCLUSION

LR is an acceptable treatment for selected patients with mid-BDC, showing less morbidity and comparable survival despite smaller lymph node retrieval.

摘要

简介

远端胆管癌（DC）的治疗方法是胰十二指肠切除术（PD），而对于未累及胰头部的中胆管癌（mid-BDC），尚无共识治疗方法。目前，PD 或肝外胆管局部切除术（LR）联合淋巴结清扫术均在使用。本研究旨在比较 PD 和 LR 治疗 mid-BDC 的效果，并参考 PD 治疗 DC 的效果。

方法

本研究为回顾性单中心研究，纳入 2000 年至 2016 年间接受 LR 治疗 mid-BDC（LR 组）、PD 治疗 mid-BDC（PD-mid 组）和 PD 治疗 DC（PD-distal 组）的连续患者。比较了临床病理特征、术后结局和生存情况。

结果

共纳入 184 例患者（LR 组 22 例，PD-mid 组 38 例，PD-distal 组 124 例）。LR 组术后无死亡病例，PD-mid 组为 5%（2/22），PD-distal 组为 3%（4/124），p=0.542。LR 组 5 例（23%）、PD-mid 组 19 例（50%）和 PD-distal 组 46 例（37%）患者发生重大并发症，p=0.103（LR 组与 PD-mid 组，p=0.038）。各组肿瘤大小、分化程度和切缘状态无差异。LR 组、PD-mid 组和 PD-distal 组的中位淋巴结切除数分别为 5（3-7）、9（7-14）和 12（8-16）个，p<0.001。LR 组、PD-mid 组和 PD-distal 组的中位总生存时间分别为 46 个月（95%CI 10-82）、19 个月（95%CI 11-27）和 29 个月（95%CI 23-35），p=0.39（LR 组与 PD-mid 组，p=0.20）。无病生存也无差异。