Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Surg. 2022 Feb 1;275(2):382-390. doi: 10.1097/SLA.0000000000004322.
To evaluate the efficacy and safety of combined vascular resection (VR) in advanced perihilar cholangiocarcinoma (PHC).
Hepatectomy combined with portal vein resection (PVR) and/or hepatic artery resection (HAR) is technically demanding but an option only for tumor eradication against PHC involving the hilar hepatic inflow vessels; however, its efficacy and safety have not been well evaluated.
Patients diagnosed with PHC during 2001-2018 were included. Patients who underwent resection were divided according to combined VR. Patients undergoing VR were subdivided according to type of VR. Postoperative outcomes and OS were compared between patient groups.
Among the 1055 consecutive patients, 787 (75%) underwent resection (without VR: n = 484, PVR: n = 157, HAR: n = 146). The incidences of postoperative complications and mortality were 49% (without VR vs with VR, 48% vs 50%; P= 0.715) and 2.1% (without VR vs with VR, 1.2% vs 3.6%; P= 0.040), respectively. The OS of patients who underwent resection with VR (median, 30 months) was shorter than that of those who underwent resection without VR (median, 61 months; P < 0.0001); however, it was longer than that of those who did not undergo resection (median, 10 months; P < 0.0001). OS was not significantly different between those who underwent PVR and those who underwent HAR (median, 29 months vs 34 months; P = 0.517).
VR salvages a large number of patients from having locally advanced PHC that is otherwise unresectable and is recommended if the hilar hepatic inflow vessels are reconstructable, providing acceptable surgical outcomes and substantial survival benefits.
评估联合血管切除术（VR）治疗高位肝门部胆管癌（PHC）的疗效和安全性。
肝切除术联合门静脉切除（PVR）和/或肝动脉切除（HAR）技术要求高，但仅适用于累及肝门流入道的 PHC 肿瘤根治；然而，其疗效和安全性尚未得到很好的评估。
纳入 2001 年至 2018 年间诊断为 PHC 的患者。根据联合 VR 对接受切除术的患者进行分组。对接受 VR 的患者根据 VR 类型进行细分。比较各组患者的术后结果和 OS。
在 1055 例连续患者中，787 例（75%）接受了切除术（无 VR：n=484，PVR：n=157，HAR：n=146）。术后并发症和死亡率的发生率分别为 49%（无 VR 组 vs 有 VR 组，48% vs 50%；P=0.715）和 2.1%（无 VR 组 vs 有 VR 组，1.2% vs 3.6%；P=0.040）。接受 VR 切除术的患者 OS（中位，30 个月）短于未接受 VR 切除术的患者（中位，61 个月；P<0.0001）；但长于未接受切除术的患者（中位，10 个月；P<0.0001）。PVR 组和 HAR 组患者的 OS 无显著差异（中位，29 个月比 34 个月；P=0.517）。
VR 使大量原本无法切除的局部晚期 PHC 患者获得治愈，并建议在肝门流入道可重建的情况下采用 VR，如果可行，这将提供可接受的手术结果和显著的生存获益。
