Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
HPB (Oxford). 2021 Nov;23(11):1751-1758. doi: 10.1016/j.hpb.2021.04.011. Epub 2021 Apr 28.
Resection for perihilar cholangiocarcinoma (pCCA) in primary sclerosing cholangitis (PSC) has been reported to lead to worse outcomes than resection for non-PSC pCCA. The aim of this study was to compare prognostic factors and outcomes after resection in patients with PSC-associated pCCA and non-PSC pCCA.
The international retrospective cohort comprised patients resected for pCCA from 21 centres (2000-2020). Patients operated with hepatobiliary resection, with pCCA verified by histology and with data on PSC status, were included. The primary outcome was overall survival. Secondary outcomes were disease-free survival and postoperative complications.
Of 1128 pCCA patients, 34 (3.0%) had underlying PSC. Median overall survival after resection was 33 months for PSC patients and 29 months for non-PSC patients (p = .630). Complications (Clavien-Dindo grade ≥ 3) were more frequent in PSC pCCA (71% versus 44%, p = .003). The rate of posthepatectomy liver failure (21% versus 17%, p = .530) and 90-day mortality (12% versus 13%, p = 1.000) was similar for PSC and non-PSC patients.
Median overall survival after resection for pCCA was similar in patients with underlying PSC and non-PSC patients. Complications were more frequent after resection for PSC-associated pCCA, with no difference in postoperative mortality.
在原发性硬化性胆管炎（PSC）患者中，肝门部胆管癌（pCCA）的切除术后预后较非PSC pCCA 更差。本研究旨在比较伴有 PSC 的 pCCA 和非 PSC pCCA 患者手术后的预后因素和结局。
国际回顾性队列纳入了 21 个中心（2000 年至 2020 年）进行 pCCA 切除术的患者。纳入标准为接受肝胆切除术、组织学证实为 pCCA 且有 PSC 状态数据的患者。主要结局为总生存率。次要结局为无病生存率和术后并发症。
在 1128 例 pCCA 患者中，34 例（3.0%）存在潜在的 PSC。PSC 患者切除术后的中位总生存率为 33 个月，而非 PSC 患者为 29 个月（p=0.630）。PSC pCCA 的并发症（Clavien-Dindo 分级≥3）更为常见（71%比 44%，p=0.003）。肝切除术后肝功能衰竭的发生率（21%比 17%，p=0.530）和 90 天死亡率（12%比 13%，p=1.000）在 PSC 和非 PSC 患者中相似。
在伴有 PSC 的 pCCA 患者中，切除术后的中位总生存率与非 PSC 患者相似。PSC 相关 pCCA 切除术后的并发症更为常见，但术后死亡率无差异。
