Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany; Department of Hepatology and Gastroenterology, Charité University Medical Center, Berlin, Germany.
HPB (Oxford). 2020 Mar;22(3):437-444. doi: 10.1016/j.hpb.2019.07.003. Epub 2019 Aug 2.
Major liver resections with portal vein resection (PVR) have emerged as the preferred treatment for patients with perihilar cholangiocarcinoma (pCCA). Whether the resection of the liver should be preferably performed as left- (LH) or right-sided hepatectomy (RH) with or without hilar en-bloc technique is still subject of ongoing debate.
Between 2011 and 2016, 91 patients with pCCA underwent surgery in curative intent at our institution. Perioperative, pathological and survival data from all consecutive patients undergoing hilar en-bloc resection for pCCA were analyzed retrospectively. Patients undergoing hepatoduodenectomy (n = 8) or ALPPS (Associating liver partition and portal vein ligation for staged hepatectomy) (n = 2) were excluded from the analysis.
Tumor grading, microvascular invasion, lymphovascular invasion, N-category, T-category, R-status and UICC-tumor staging were similar in the RH (n = 45) and LH (n = 36) groups. Perioperative morbidity and mortality were higher after RH compared to LH (mortality: 15.6% (7/45) vs. 8.3% (3/36) p = 0.003). Three-year (62% vs. 51%) and the 5-year OS (30% vs. 46%) were comparable between LH and RH groups respectively (p = 0.519, log rank).
The present study supports the concept of surgically aggressive therapy in pCCA. LH and RH hilar en-bloc resection demonstrate a comparable long-term survival, suggesting that LH hilar en-bloc resections are feasible and safe in high-volume centers.
对于肝门部胆管癌（pCCA）患者，大范围肝切除术联合门静脉切除（PVR）已成为首选治疗方法。是否应优先行左（LH）或右半肝切除术（RH），是否联合肝门整块切除技术，目前仍存在争议。
2011 年至 2016 年，我院共对 91 例 pCCA 患者行根治性手术。回顾性分析所有连续接受肝门整块切除术治疗 pCCA 的患者的围手术期、病理和生存数据。排除行肝十二指肠切除术（n=8）或联合肝脏分隔和门静脉结扎的逐步肝切除术（ALPPS，n=2）的患者。
RH 组（n=45）和 LH 组（n=36）的肿瘤分级、微血管侵犯、淋巴血管侵犯、N 分期、T 分期、R 状态和 UICC 肿瘤分期相似。与 LH 相比，RH 术后的发病率和死亡率更高（死亡率：15.6%（7/45）比 8.3%（3/36），p=0.003）。LH 组和 RH 组的 3 年（62%比 51%）和 5 年 OS（30%比 46%）分别相当（p=0.519，log rank）。
本研究支持在 pCCA 中采用积极手术治疗的理念。LH 和 RH 肝门整块切除术显示出相似的长期生存，这表明在高容量中心行 LH 肝门整块切除术是可行和安全的。
