胆管内乳头状肿瘤：一项欧洲回顾性多中心观察性研究（EUR-IPNB 研究）。
Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study).
机构信息
Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA.
Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza.
出版信息
Int J Surg. 2023 Apr 1;109(4):760-771. doi: 10.1097/JS9.0000000000000280.
BACKGROUND/PURPOSE: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers.
METHODS
A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days.
RESULTS
A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 ( P =0.016), intrahepatic versus extrahepatic tumor ( P =0.027), single versus multiple tumors ( P =0.007), those who underwent hepatic versus pancreatic resection ( P =0.017), or achieved versus failed TO ( P =0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P =0.03) was an independent prognostic factor of poor overall survival.
CONCLUSIONS
Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
背景/目的：胆管内乳头状肿瘤（IPNB）在西方国家较为罕见。本研究的主要目的是描述主要来自欧洲参与中心的当前手术策略和结果。
方法
在欧洲-非洲肝胆胰协会的支持下，收集了 2010 年 1 月 1 日至 2020 年 12 月 31 日期间接受手术治疗的 IPNB 患者的多机构回顾性系列。教科书结果（TO）定义为非延长住院时间加上术后 90 天内无任何 Clavien-Dindo 分级至少 III 级并发症、再入院或死亡。
结果
共有 28 个中心贡献了 85 名接受 IPNB 手术的患者。中位年龄为 66 岁（55-72 岁），49.4%为女性，87.1%为白种人。72 例（84.7%）患者接受开放手术，13 例（15.3%）接受腹腔镜手术。TO 达到 54.1%，肝切除后达到 63.8%，胰腺切除后达到 32.0%。中位总生存时间为 5.72 年，5 年总生存率为 63%（95%CI：50-82）。Charlson 合并症评分≤4 分的患者总生存时间优于>4 分（P=0.016），肝内肿瘤优于肝外肿瘤（P=0.027），单发肿瘤优于多发肿瘤（P=0.007），行肝切除术优于胰腺切除术（P=0.017），达到 TO 优于未达到 TO（P=0.029）。多变量 Cox 回归分析显示，未达到 TO（HR：4.20；95%CI：1.11-15.94；P=0.03）是总生存不良的独立预后因素。
结论
接受肝切除术治疗 IPNB 的患者比需要胰腺切除术的患者更有可能达到 TO 结果。合并症、肿瘤位置和肿瘤数量影响总生存。TO 是总生存的独立预后因素。
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