You Yunghun, Heo Jin S, Shin Sang H, Shin Sung W, Park Hong S, Park Kwang B, Cho Sung K, Hyun Dongho, Han In W
Department of Surgery, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
HPB (Oxford). 2022 May;24(5):635-644. doi: 10.1016/j.hpb.2021.09.011. Epub 2021 Sep 24.
Preoperative biliary drainage (PBD) followed by portal vein embolization (PVE) has increased the chance of resection for hilar cholangiocarcinoma (CCC). We aim to identify the optimal timing of PVE after PBD in patients undergoing hepatectomy for hilar CCC.
We retrospectively reviewed 64 patients who underwent hepatectomy after PBD and PVE for hilar CCC. The patients were classified into 3 groups: Group 1 (PBD-PVE interval ≤7 days), Group2 (8-14 days) and Group 3 (>14 days). The primary end points were 90 days mortality and grade B/C posthepatectomy liver failure (PHLF).
There was no significant difference in primary end points between three groups. A marginally significant difference was found in the incidence of Clavien-Dindo grade ≥3 complications and wound infection (57.1% vs 38.1% vs 72.4%, p = 0.053 and 21.4% vs 38.1% vs 55.2%, p = 0.099). In multivariable analysis, Bismuth type IIIb or IV was independent risk factors for grade B/C PHLF (HR: 4.782, 95% CI 1.365-16.759, p = 0.014).
Considering that the PBD-PVE interval did not affect PHLF, and the surgical complications increased as the interval increases, PVE as early as possible after PBD would be beneficial.
术前胆道引流（PBD）联合门静脉栓塞（PVE）增加了肝门部胆管癌（CCC）的切除机会。我们旨在确定接受肝门部CCC肝切除术的患者在PBD后进行PVE的最佳时机。
我们回顾性分析了64例接受PBD和PVE后行肝门部CCC肝切除术的患者。患者分为3组：第1组（PBD-PVE间隔≤7天）、第2组（8-14天）和第3组（>14天）。主要终点为90天死亡率和B/C级肝切除术后肝功能衰竭（PHLF）。
三组之间的主要终点无显著差异。在Clavien-Dindo≥3级并发症和伤口感染的发生率上发现了微小的显著差异（57.1%对38.1%对72.4%，p = 0.053；21.4%对38.1%对55.2%，p = 0.099）。在多变量分析中，Bismuth IIIb型或IV型是B/C级PHLF的独立危险因素（HR：4.782，95%CI 1.365-16.759，p = 0.014）。
考虑到PBD-PVE间隔不影响PHLF，且手术并发症随间隔增加而增加，PBD后尽早进行PVE将是有益的。
