保留肝实质的肝切除术提高单发小肝内胆管细胞癌的可切除性和生存率。

Parenchyma-sparing hepatectomy improves salvageability and survival for solitary small intrahepatic cholangiocarcinoma.

机构信息

Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.

Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

出版信息

HPB (Oxford). 2021 Jun;23(6):882-888. doi: 10.1016/j.hpb.2020.10.006. Epub 2020 Nov 11.

DOI:10.1016/j.hpb.2020.10.006

PMID:33187828

Abstract

BACKGROUND

This study aimed to investigate the prognostic impact of parenchyma-sparing hepatectomy (PSH) on solitary small intrahepatic cholangiocarcinoma (ICC).

METHODS

A total of 184 patients with solitary small ICC (≤ 5 cm) from 2009 to 2017 were included. Short- and long-term outcomes were compared between PSH and Non-PSH approach.

RESULTS

95 (51.6%) patients underwent PSH and 89 (48.4%) patients underwent Non-PSH for solitary small ICC. PSH was associated with less intraoperative blood loss (212.9 mL versus 363.5 mL, P=0.038), lower transfusion rate (7.4% versus 16.9%, P=0.048), without increasing the frequency of tumor recurrence (60.0% versus 58.4%). No significant differences were observed in overall survival (OS), recurrence-free survival (RFS) and liver RFS (P = 0.627, 0.769 and 0.538, respectively). 109 (59.2%) patients experienced recurrence, of these, 67 (36.4%) were intrahepatic recurrence. Subgroup analysis of patients with liver-only recurrence demonstrated an increased likelihood of repeat hepatectomy for PSH compared to Non-PSH (21.2% versus 2.9%, P = 0.031), thus resulting in improved liver OS (P = 0.016).

CONCLUSION

PSH was associated with improved perioperative outcomes but it did not increase liver recurrence rates. PSH offered an increased rate of salvage hepatectomy for recurrent tumor, thus improving long-term survival in cases in which liver recurrence occurred.

摘要

背景

本研究旨在探讨保留肝实质的肝切除术（PSH）对单发小肝内胆管癌（ICC）的预后影响。

方法

共纳入 2009 年至 2017 年间 184 例单发小 ICC（≤5cm）患者。比较 PSH 与非 PSH 方法的短期和长期结果。

结果

95 例（51.6%）患者行 PSH，89 例（48.4%）患者行非 PSH 治疗单发小 ICC。PSH 术中出血量更少（212.9ml 比 363.5ml，P=0.038），输血率更低（7.4%比 16.9%，P=0.048），肿瘤复发率无增加（60.0%比 58.4%）。总生存（OS）、无复发生存（RFS）和肝无复发生存（LRFS）无显著差异（P=0.627、0.769 和 0.538）。109 例（59.2%）患者发生复发，其中 67 例（36.4%）为肝内复发。仅肝复发患者的亚组分析显示，PSH 患者再次肝切除的可能性高于非 PSH 患者（21.2%比 2.9%，P=0.031），从而改善了肝 OS（P=0.016）。