Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan.
Ann Surg. 2022 Jul 1;276(1):146-152. doi: 10.1097/SLA.0000000000004465. Epub 2020 Sep 1.
To evaluate the impact of complications on long-term survival in patients with perihilar cholangiocarcinoma.
Surgical resection for perihilar cholangiocarcinoma is vulnerable to postoperative complications. The prognostic impact of complications in patients with this disease is unknown.
The medical records of patients who underwent curative-intent hepatectomy for perihilar cholangiocarcinoma between 2010 and 2017 were reviewed retrospectively. The comprehensive complication index (CCI) was calculated based on all postoperative complications, which were graded by the Clavien-Dindo classification (CDC). Patients were divided into high and low CCI groups by the median score, and survival was compared between the 2 groups.
Excluding 8 patients who died in hospital, 369 patients were analyzed. The CDC grade was I in 20 (5.4%), II in 108 (29.3%), III in 224 (60.7%), and IV in 17 (4.6%) patients. The CCI increased with increasing CDC grade; the median was 42.9 (range, 15.0-98.9). Overall survival differed significantly between the high (n = 187) and low (n = 182) CCI groups (41.2% vs 47.9% at 5 years; P = 0.041). However, multivariable analyses demonstrated that traditional clinicopathological factors were independent predictors of survival and that the dichotomized CCI was not. In addition, the CCI score as a continuous variable was not an independent prognostic factor for overall survival in the multivariable analyses (hazard ratio per 1 CCI score: 1.00, 95% confidence interval: 0.99-1.01, P = 0.775).
Cumulative postoperative complications after resection of perihilar cholangiocarcinoma only moderately deteriorate long-term survival, and should not be an argument to deny surgery in this high-risk population.
评估并发症对肝门周围胆管癌患者长期生存的影响。
肝门周围胆管癌的手术切除易发生术后并发症。该疾病患者并发症的预后影响尚不清楚。
回顾性分析 2010 年至 2017 年间接受根治性肝切除术的肝门周围胆管癌患者的病历。根据术后所有并发症，采用 Clavien-Dindo 分级（CDC）计算综合并发症指数（CCI）。根据中位数将患者分为高 CCI 组和低 CCI 组，并比较两组的生存情况。
排除 8 例住院死亡患者后，共分析了 369 例患者。CDC 分级为 I 级的有 20 例（5.4%），II 级的有 108 例（29.3%），III 级的有 224 例（60.7%），IV 级的有 17 例（4.6%）。CCI 随 CDC 分级的增加而增加；中位数为 42.9（范围 15.0-98.9）。高 CCI 组（n=187）和低 CCI 组（n=182）的总生存率差异有统计学意义（5 年时分别为 41.2%和 47.9%；P=0.041）。然而，多变量分析表明，传统的临床病理因素是生存的独立预测因素，而二分 CCI 不是。此外，CCI 评分作为连续变量在多变量分析中不是总生存的独立预后因素（每增加 1 CCI 评分的风险比：1.00，95%置信区间：0.99-1.01，P=0.775）。
肝门周围胆管癌切除术后累积术后并发症仅适度降低长期生存率，不应成为拒绝为这一高危人群进行手术的理由。
