Division of Hepato-Biliary-Pancreatic Surgery.
Division of Plastic and Reconstructive Surgery.
BJS Open. 2021 Jul 6;5(4). doi: 10.1093/bjsopen/zrab064.
Hepatectomy with vascular resection (VR) for perihilar cholangiocarcinoma (PHCC) is a challenging procedure. However, only a few reports on this procedure have been published and its clinical significance has not been fully evaluated.
Patients undergoing surgical resection for PHCC from 2002-2017 were studied. The surgical outcomes of VR and non-VR groups were compared.
Some 238 patients were included. VR was performed in 85 patients. The resected vessels were hepatic artery alone (31 patients), portal vein alone (37 patients) or both (17 patients). The morbidity rates were almost the same in the VR (49.4 per cent) and non-VR (43.8 per cent) groups (P = 0.404). The mortality rates of VR (3.5 per cent) and non-VR (3.3 per cent) were also comparable (P > 0.999). The median survival time (MST) was 45 months in the non-VR group and 36 months in VR group (P = 0.124). Among patients in whom tumour involvement was suspected on preoperative imaging and whose carbohydrate antigen 19-9 (CA19-9) value was 37 U/ml or less, MST in the VR group was significantly longer than that in the non-VR group (50 versus 34 months, P = 0.017). In contrast, when the CA19-9 value was greater than 37 U/ml, MST of the VR and non-VR groups was comparable (28 versus 29 months, P = 0.520).
Hepatectomy with VR for PHCC can be performed in a highly specialized hepatobiliary centre with equivalent short- and long-term outcomes to hepatectomy without VR.
肝切除术联合血管切除术（VR）治疗肝门部胆管癌（PHCC）是一项具有挑战性的手术。然而，仅有少数关于该手术的报道，其临床意义尚未得到充分评估。
研究了 2002 年至 2017 年期间接受手术切除 PHCC 的患者。比较了 VR 组和非 VR 组的手术结果。
共纳入 238 例患者，其中 85 例行 VR。切除的血管仅为肝动脉（31 例）、门静脉（37 例）或两者均有（17 例）。VR 组（49.4%）和非 VR 组（43.8%）的发病率几乎相同（P=0.404）。VR 组（3.5%）和非 VR 组（3.3%）的死亡率也相似（P＞0.999）。非 VR 组的中位生存时间（MST）为 45 个月，VR 组为 36 个月（P=0.124）。在术前影像学怀疑肿瘤累及且癌抗原 19-9（CA19-9）值为 37U/ml 或更低的患者中，VR 组的 MST 明显长于非 VR 组（50 与 34 个月，P=0.017）。相反，当 CA19-9 值大于 37U/ml 时，VR 组和非 VR 组的 MST 无差异（28 与 29 个月，P=0.520）。
在高度专业化的肝胆中心，肝切除术联合 VR 治疗 PHCC 可获得与无 VR 肝切除术相当的短期和长期结果。
