Lee Sung Ho, Choi Gi Hong, Han Dai Hoon, Kim Kyung Sik, Choi Jin Sub, Rho Seoung Yoon
Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2021 Feb 28;25(1):62-70. doi: 10.14701/ahbps.2021.25.1.62.
BACKGROUNDS/AIMS: Despite advances in surgical techniques and perioperative supportive care, radical resection of hilar cholangiocarcinoma is the only modality that can achieve long-term survival. We chronologically investigated surgical and oncological outcomes of hilar cholangiocarcinoma and analyzed the factors affecting overall survival.
We retrospectively enrolled 165 patients with hilar cholangiocarcinoma who underwent liver resection with a curative intent. The patients were divided into groups based on the period when the surgery was performed: period I (2005-2011) and period II (2012-2018). The clinicopathological characteristics, perioperative outcomes, and survival outcomes were analyzed.
The patients' age, serum CA19-9 levels, and serum bilirubin levels at diagnosis were significantly higher in the period I group. There were no differences in pathological characteristics such as tumor stage, histopathologic status, and resection status. However, perioperative outcomes, such as estimated blood loss (1528.8 vs. 1034.1 mL, =0.020) and postoperative severe complication rate (51.3% vs. 26.4%, =0.022), were significantly lower in the period II group. Regression analysis demonstrated that period I (hazard ratio [HR]=1.591; 95% confidence interval [CI]=1.049-2.414; =0.029), preoperative serum bilirubin at diagnosis (HR=1.585; 95% CI=1.058-2.374; =0.026), and tumor stage (III, IV) (HR=1.671; 95% CI: 1.133-2.464; =0.010) were significantly associated with poor prognosis. The 5-year survival rate was better in the period II patients than in the period I patients (35.1% vs. 21.0%, =0.0071).
The surgical and oncological outcomes were better in period II. Preoperative serum bilirubin and advanced tumor stage were associated with poor prognosis in patients with hilar cholangiocarcinoma.
背景/目的：尽管手术技术和围手术期支持治疗取得了进展，但肝门部胆管癌的根治性切除是唯一能够实现长期生存的治疗方式。我们按时间顺序研究了肝门部胆管癌的手术和肿瘤学结果，并分析了影响总生存期的因素。
我们回顾性纳入了165例接受根治性肝切除的肝门部胆管癌患者。根据手术时间将患者分为两组：第一期（2005 - 2011年）和第二期（2012 - 2018年）。分析临床病理特征、围手术期结果和生存结果。
第一期组患者诊断时的年龄、血清CA19 - 9水平和血清胆红素水平显著更高。在肿瘤分期、组织病理学状态和切除状态等病理特征方面没有差异。然而，第二期组的围手术期结果，如估计失血量（1528.8 vs. 1034.1 mL，P = 0.020）和术后严重并发症发生率（51.3% vs. 26.4%，P = 0.022）显著更低。回归分析表明，第一期（风险比[HR]=1.591；95%置信区间[CI]=1.049 - 2.414；P = 0.029）、诊断时术前血清胆红素（HR=1.585；95% CI=1.058 - 2.374；P = 0.026）和肿瘤分期（III、IV期）（HR=1.671；95% CI：1.133 - 2.464；P = 0.010）与预后不良显著相关。第二期患者的5年生存率优于第一期患者（35.1% vs. 21.0%，P = 0.0071）。
第二期的手术和肿瘤学结果更好。术前血清胆红素和肿瘤晚期与肝门部胆管癌患者的预后不良相关。
