Sato Katsuhiko, Shigekawa Minoru, Kozumi Kazuhiro, Okabe Junya, Sato Yu, Tamura Takeshi, Yoshioka Teppei, Sakamori Ryotaro, Iwagami Yoshifumi, Yamada Daisaku, Tomimaru Yoshito, Noda Takehiro, Takahashi Hidenori, Kobayashi Shogo, Eguchi Hidetoshi, Tatsumi Tomohide, Takehara Tetsuo
Department of Gastroenterology and Hepatology Osaka University Graduate School of Medicine Osaka Japan.
Department of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka Japan.
DEN Open. 2022 May 22;3(1):e127. doi: 10.1002/deo2.127. eCollection 2023 Apr.
Perihilar cholangiocarcinoma (PCC) is a complex disorder involving the hepatic hilum. Multiple endoscopic retrograde cholangiopancreatography sessions are necessary for diagnosis and treatment with underlying cholangitis risk. Our aim is to clarify the initial-drainage-related prognostic factors of PCC.
This study was a single-center retrospective study. A total of 104 consecutive patients diagnosed with PCC from January 2010 to February 2020 were enrolled. We defined the diagnostic period as the time between the first biliary drainage attempt and the final drainage when treatment, including surgery or chemotherapy, was started. We focused on this initial period and analyzed the endoscopy-related factors that affected mortality.
Overall survival of all PCC patients was 599 days. Overall survival of surgically treated patients and unresectable patients were 893 days and 512 days, respectively. In 48 surgically treated patients, drainage-related cholangitis within the diagnostic period, defined as new cholangitis that occurred after the first biliary drainage attempt, worsened overall survival from 1460 days to 607 days. Endoscopic sphincterotomy, the first drainage method other than endoscopic nasobiliary drainage, and four or more endoscopic retrograde cholangiopancreatography sessions were risk factors for drainage-related cholangitis. Drainage-related cholangitis increased pathological lymph node metastasis. Percutaneous transhepatic biliary drainage as final drainage was the only prognostic factor in unresectable chemotherapy-treated patients.
Drainage-related cholangitis worsened the prognosis in PCC patients who underwent surgery. Appropriate endoscopic retrograde cholangiopancreatography strategies, especially during the diagnostic period, are of great importance in PCC.
肝门部胆管癌（PCC）是一种累及肝门的复杂疾病。诊断和治疗需要多次内镜逆行胰胆管造影术，存在潜在胆管炎风险。我们的目的是阐明PCC与初始引流相关的预后因素。
本研究为单中心回顾性研究。纳入了2010年1月至2020年2月期间连续诊断为PCC的104例患者。我们将诊断期定义为首次胆道引流尝试至开始治疗（包括手术或化疗）时的最终引流之间的时间。我们关注这一初始阶段，分析影响死亡率的内镜相关因素。
所有PCC患者的总生存期为599天。手术治疗患者和不可切除患者的总生存期分别为893天和512天。在48例手术治疗患者中，诊断期内与引流相关的胆管炎（定义为首次胆道引流尝试后发生的新胆管炎）使总生存期从1460天缩短至607天。内镜括约肌切开术、除内镜鼻胆管引流外的首次引流方法以及四次或更多次内镜逆行胰胆管造影术是与引流相关胆管炎的危险因素。与引流相关的胆管炎增加了病理淋巴结转移。经皮经肝胆道引流作为最终引流是不可切除化疗治疗患者唯一的预后因素。
与引流相关的胆管炎使接受手术的PCC患者的预后恶化。适当的内镜逆行胰胆管造影策略，尤其是在诊断期，对PCC非常重要。
