Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Langenbecks Arch Surg. 2023 Jan 23;408(1):58. doi: 10.1007/s00423-022-02749-5.
This study aimed to elucidate the safety and oncological outcomes of surgery with hepatic artery resection (HAR) for patients with distal cholangiocarcinoma.
The clinical data of patients with distal cholangiocarcinoma who underwent curative intent surgery at Hiroshima University between March 2009 and January 2021 were retrospectively analyzed. Eligible patients were classified according to the presence or absence of HAR (HAR and non-HAR group), and clinicopathological features and disease-free survival rates were compared between the two groups.
Among the 60 patients analyzed, eight patients had received HAR, and the remaining 52 patients had not. The rate of portal vein resection, T stage, and the number of metastasized lymph nodes in the HAR group were significantly greater than those in the non-HAR group (p < 0.001, p = 0.00695, and p = 0.0480, respectively). Postoperative severe complication was confirmed in one patient, and there were no in-hospital deaths in the HAR group. Seven of 8 patients in the HAR group showed recurrence during follow-up, and of those, six patients showed early recurrence within 1 year postoperatively. The disease-free survival time in the HAR group was significantly shorter than that in the non-HAR group (median: 7.4 m vs. 34.2 m, respectively) (p < 0.001). Multivariate analysis revealed that lymph node metastasis and HAR were significant risk factors for predicting the adverse disease-free survival time (hazard ratio (HR), 3.21; p = 0.0142; HR, 4.47; p = 0.0346, respectively).
Patients with distal cholangiocarcinoma who underwent surgery with HAR tended to show early recurrences, although HAR could be performed safely.
本研究旨在阐明肝动脉切除（HAR）手术治疗远端胆管癌的安全性和肿瘤学结果。
回顾性分析 2009 年 3 月至 2021 年 1 月期间在广岛大学接受根治性手术治疗的远端胆管癌患者的临床资料。根据是否存在 HAR（HAR 组和非 HAR 组）对合格患者进行分类，并比较两组的临床病理特征和无病生存率。
在分析的 60 例患者中，8 例接受了 HAR，其余 52 例未接受。HAR 组的门静脉切除率、T 分期和转移淋巴结数明显大于非 HAR 组（p<0.001、p=0.00695 和 p=0.0480）。1 例患者术后发生严重并发症，HAR 组无院内死亡。HAR 组 8 例患者中有 7 例在随访期间复发，其中 6 例在术后 1 年内出现早期复发。HAR 组的无病生存时间明显短于非 HAR 组（中位数：7.4 个月与 34.2 个月）（p<0.001）。多因素分析显示，淋巴结转移和 HAR 是预测不良无病生存时间的显著危险因素（风险比（HR），3.21；p=0.0142；HR，4.47；p=0.0346）。
尽管 HAR 可以安全进行，但接受 HAR 手术治疗的远端胆管癌患者往往会出现早期复发。
