Skalický P, Tesaříková J, Gregořík M, Knápková K, Švébišová H, Kurfúrstová D, Klos D, Loveček M
Rozhl Chir. 2022 Fall;101(9):436-442. doi: 10.33699/PIS.2022.101.9.436-442.
The prognosis of extrahepatic cholangiocarcinoma is dismal and the only way to achieve long-term survival is surgical resection. While pancreatoduodenectomy (PD) is the standard procedure for distal cholangiocarcinoma (distal bile duct cancer; DBDC), bile duct segmental resection (BDR) can be used as an alternative approach for middle bile duct cholangiocarcinoma (middle bile duct cancer; MBDC). The aim of the study was to calculate the short-term and long-term outcomes of curative-intent surgery in distal bile duct cholangiocarcinoma patients.
A retrospective cohort study of consecutive patients treated for MBDC and DBDC with PD or BDR between 1/2009-12/2019. The patients were divided according to the type of surgical resection (PD and BDR group). Demographic, clinicopathological and histopathological data and overall survival (OS) were evaluated in both groups. OS was estimated using the Kaplan-Meier analysis.
The study comprised a total of 62 patients - 45 patients (72.6%) in the PD group and 17 (27.4%) in the BDR group. Patients undergoing BDR were significantly older than those receiving PD (p=0.048). Men predominated in the PD group (N=34/45; 75.6%) while more women were included in the BDR group (N=10/17; 58.8%). Median age was higher in the BDR group (p=0.048). Serious morbidity (Clavien-Dindo III-V) (33.3% vs 11.8%), 30-day and 90-day mortality (4.4% vs 0.0% and 8.9% vs 5.9%, respectively) predominated in the PD group although the differences were not statistically significant, as well as a longer hospital stay (16.0 days vs 11.0 days; p=0.002). Pathological assessments revealed comparable numbers of positive lymph nodes in both groups, but a significantly higher number of total resected lymph nodes in the PD group (p.
肝外胆管癌的预后很差，实现长期生存的唯一方法是手术切除。虽然胰十二指肠切除术（PD）是远端胆管癌（远端胆管癌；DBDC）的标准手术，但胆管节段性切除术（BDR）可作为中段胆管癌（中段胆管癌；MBDC）的替代方法。本研究的目的是计算远端胆管癌患者根治性手术的短期和长期结果。
对2009年1月至2019年12月期间接受PD或BDR治疗的MBDC和DBDC连续患者进行回顾性队列研究。患者根据手术切除类型（PD和BDR组）进行分组。对两组患者的人口统计学、临床病理和组织病理学数据以及总生存期（OS）进行评估。采用Kaplan-Meier分析估计OS。
该研究共纳入62例患者，其中PD组45例（72.6%），BDR组17例（27.4%）。接受BDR的患者明显比接受PD的患者年龄大（p=0.048）。PD组男性居多（N=34/45；75.6%），而BDR组女性更多（N=10/17；58.8%）。BDR组的中位年龄更高（p=0.048）。PD组严重并发症（Clavien-Dindo III-V级）（33.3%对11.8%）、30天和90天死亡率（分别为4.4%对0.0%和8.9%对5.9%）占主导地位，尽管差异无统计学意义，住院时间也更长（16.0天对11.0天；p=0.002）。病理评估显示两组阳性淋巴结数量相当，但PD组总切除淋巴结数量明显更多（p.
