Nakagohri Toshio, Takahashi Shinichiro, Ei Shigenori, Masuoka Yoshihito, Mashiko Taro, Ogasawara Toshihito, Hirabayashi Kenichi
Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa Prefecture, 259-1193, Japan.
Department of Pathology, Toyama University School of Medicine, 3190 Gohuku, Toyama, Toyama Prefecture, 930-8555, Japan.
World J Surg. 2023 Apr;47(4):1034-1041. doi: 10.1007/s00268-023-06889-7. Epub 2023 Feb 3.
A positive ductal margin is strongly associated with poor survival in patients with distal cholangiocarcinoma. However, the significance of the radial margin status and its effect on survival are not fully clarified.
All patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy between January 2000 and December 2018 at Tokai University Hospital were retrospectively analyzed. Positive margins were divided into positive ductal margin and positive radial margin.
One hundred and eight consecutive patients with distal cholangiocarcinoma underwent pancreatoduodenectomy. Margin-negative R0 resection was performed in 85 patients (79%). Twenty-three patients (21%) had a positive resection margin (R1 resection). The 5-year survival rate and median overall survival for patients with R0 resection and those with R1 resection was 64%, 98 months and 25%, 26 months, respectively. There was a significant difference in survival between patients with R0 resection and those with R1 resection (p < 0.001). Patients with positive radial margin (n = 10) had a significantly worse outcome than those with positive ductal margin (n = 13) (p = 0.016). Univariate analysis showed that R1 resection, lymph node metastasis, tumor depth, portal vein invasion, pancreatic invasion, lymphatic invasion, and venous invasion were significant prognostic factors. Multivariate analysis confirmed that R1 resection and nodal involvement were significant independent prognostic indicators after surgical resection for distal cholangiocarcinoma.
Positive surgical margin and nodal involvement were the strongest predictors of poor survival in patients with distal cholangiocarcinoma. Patients with a positive radial margin had a significantly worse outcome than those with a positive ductal margin.
胆管切缘阳性与远端胆管癌患者的不良生存密切相关。然而，切缘的径向状态的意义及其对生存的影响尚未完全阐明。
回顾性分析2000年1月至2018年12月在东海大学医院接受胰十二指肠切除术的所有远端胆管癌患者。切缘阳性分为胆管切缘阳性和径向切缘阳性。
108例连续的远端胆管癌患者接受了胰十二指肠切除术。85例患者（79%）进行了切缘阴性的R0切除。23例患者（21%）切缘阳性（R1切除）。R0切除患者和R1切除患者的5年生存率和中位总生存期分别为64%、98个月和25%、26个月。R0切除患者和R1切除患者的生存存在显著差异（p<0.001）。径向切缘阳性的患者（n=10）的预后明显比胆管切缘阳性的患者（n=13）差（p=0.016）。单因素分析显示，R1切除、淋巴结转移、肿瘤深度、门静脉侵犯、胰腺侵犯、淋巴管侵犯和静脉侵犯是重要的预后因素。多因素分析证实，R1切除和淋巴结受累是远端胆管癌手术切除后重要的独立预后指标。
手术切缘阳性和淋巴结受累是远端胆管癌患者生存不良的最强预测因素。径向切缘阳性的患者的预后明显比胆管切缘阳性的患者差。
