肝外胆管癌中段胆管节段切除术的获益与局限性。

Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma.

机构信息

Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.

出版信息

Hepatobiliary Pancreat Dis Int. 2020 Apr;19(2):147-152. doi: 10.1016/j.hbpd.2020.01.002. Epub 2020 Jan 30.

DOI:10.1016/j.hbpd.2020.01.002

PMID:32037277

Abstract

BACKGROUND

Pancreaticoduodenectomy (PD) is a standardized strategy for patients with middle and distal bile duct cancers. The aim of this study was to compare clinicopathological features of bile duct segmental resection (BDR) with PD in patients with extrahepatic cholangiocarcinoma.

METHODS

Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR (n = 21) or PD (n = 84) with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present study.

RESULTS

Patients who underwent PD were significantly younger than those receiving BDR. The frequency of preoperative jaundice, biliary drainage and cholangitis was not significantly different between the two groups. The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group (553 vs. 421 min, and 770 vs. 402 mL; both P<0.01). More major complications (>Clavien-Dindo IIIa) were observed in the PD group (46% vs. 10%, P<0.01). Postoperative hospital stay was also longer in that group (30 vs. 19 days, P = 0.02). Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups (33% in BDR and 48% in PD, P = 0.24). The rate of R0 resection was significantly higher in the PD group (80% vs. 38%, P<0.01). Adjuvant chemotherapy was more frequently administered to patients in the BDR group (62% vs. 38%, P = 0.04). Although 5-year overall survival rates were similar in both groups (44% for BDR and 51% for PD, P = 0.72), in patients with T1 and T2, the BDR group tended to have poorer prognosis (44% vs. 68% at 5-year, P = 0.09).

CONCLUSIONS

BDR was comparable in prognosis to PD in middle bile duct cancer. Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.

摘要

背景

胰十二指肠切除术（PD）是治疗中下段胆管癌的标准策略。本研究旨在比较肝外胆管癌患者胆管节段切除术（BDR）与 PD 的临床病理特征。

方法

本研究纳入了 2000 年 1 月至 2016 年 12 月期间在神户大学医院接受 BDR（n=21）或 PD（n=84）治疗且达到 R0 或 R1 切除的连续病例。

结果

接受 PD 的患者明显比接受 BDR 的患者年轻。两组术前黄疸、胆道引流和胆管炎的发生率无显著差异。PD 组手术时间较长，术中出血量较多（553 比 421 分钟，770 比 402 毫升；均 P<0.01）。PD 组发生更多的主要并发症（>Clavien-Dindo IIIa）（46%比 10%，P<0.01）。PD 组的术后住院时间也更长（30 比 19 天，P=0.02）。病理评估显示 BDR 组肿瘤进展程度较低，但两组淋巴结转移率相似（BDR 组 33%，PD 组 48%，P=0.24）。PD 组 R0 切除率显著较高（80%比 38%，P<0.01）。BDR 组更常接受辅助化疗（62%比 38%，P=0.04）。两组 5 年总生存率相似（BDR 组 44%，PD 组 51%，P=0.72），但在 T1 和 T2 期患者中，BDR 组的预后较差（5 年时分别为 44%和 68%，P=0.09）。