Department of Surgery, Bahcesehir University School of Medicine, Istanbul, Turkey.
Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Germany.
Surgery. 2023 Jun;173(6):1398-1404. doi: 10.1016/j.surg.2023.02.008. Epub 2023 Mar 22.
Associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma has been considered to be contraindicated due to the initial poor results. Given the recent reports of improved outcomes, we aimed to collect the recent experiences of different centers performing associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma to analyze factors related to improved outcomes.
This proof-of-concept study collected contemporary cases of associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma and analyzed for morbidity, short and long-term survival, and factors associated with outcomes.
In total, 39 patients from 8 centers underwent associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma from 2010 to 2020. The median preoperative future liver remnant volume was 323 mL (155-460 mL). The median future liver remnant increase was 58.7% (8.9% -264.5%) with a median interstage interval of 13 days (6-60 days). Post-stage 1 and post-stage 2 biliary leaks occurred in 2 (7.7%) and 4 (15%) patients. Six patients (23%) after stage 1 and 6 (23%) after stage 2 experienced grade 3 or higher complications. Two patients (7.7%) died within 90 days after stage 2. The 1-, 3-, and 5-year survival was 92%, 69%, and 55%, respectively. A subgroup analysis revealed poor survival for patients undergoing additional vascular resection and lymph node positivity. Lymph node-negative patients showed excellent survival demonstrated by 1-, 3-, and 5-year survival of 86%, 86%, and 86%.
This study highlights that the critical attitude toward associating liver partition and portal vein ligation for staged hepatectomy for perihilar cholangiocarcinoma needs to be revised. In selected patients with perihilar cholangiocarcinoma, associating liver partition and portal vein ligation for staged hepatectomy can achieve favorable survival that compares to the outcome of established surgical treatment strategies reported in benchmark studies for perihilar cholangiocarcinoma including 1-stage hepatectomy and liver transplantation.
由于初始结果较差，对于肝门部胆管癌的分阶段肝切除术，关联肝脏分割和门静脉结扎术曾被认为是禁忌。鉴于最近报道的结果改善，我们旨在收集不同中心进行肝门部胆管癌分阶段肝切除术的关联肝脏分割和门静脉结扎术的最新经验，以分析与改善结果相关的因素。
本概念验证研究收集了肝门部胆管癌分阶段肝切除术的关联肝脏分割和门静脉结扎术的当代病例，并对发病率、短期和长期生存率以及与结果相关的因素进行了分析。
共有 8 个中心的 39 例患者于 2010 年至 2020 年期间接受了肝门部胆管癌的关联肝脏分割和门静脉结扎术分阶段肝切除术。术前预估剩余肝脏体积中位数为 323ml（155-460ml）。肝脏剩余体积增加中位数为 58.7%（8.9%-264.5%），术间间隔中位数为 13 天（6-60 天）。第一阶段和第二阶段胆管漏发生在 2 例（7.7%）和 4 例（15%）患者中。第一阶段后 6 例（23%）和第二阶段后 6 例（23%）患者发生 3 级或更高级别的并发症。2 例（7.7%）患者在第二阶段后 90 天内死亡。1、3 和 5 年生存率分别为 92%、69%和 55%。亚组分析显示，进行额外血管切除和淋巴结阳性的患者生存较差。淋巴结阴性患者的生存情况良好，1、3 和 5 年生存率分别为 86%、86%和 86%。
本研究表明，对于肝门部胆管癌的分阶段肝切除术，关联肝脏分割和门静脉结扎术的关键态度需要进行修正。在选定的肝门部胆管癌患者中，关联肝脏分割和门静脉结扎术分阶段肝切除术可以获得良好的生存，与基准研究中报道的肝门部胆管癌的既定治疗策略（包括 1 阶段肝切除术和肝移植）的结果相当。
