Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Langenbecks Arch Surg. 2023 Mar 29;408(1):128. doi: 10.1007/s00423-023-02854-z.
The survival rate of patients with irresectable perihilar cholangiocarcinoma is remarkably poor. An essential part of palliation is treatment of obstructive cholestasis caused by the tumor. Currently, this is mainly performed endoscopically by stent or via PTBD, requiring frequent changes of the stents and limiting health-related quality of life due to the multiple hospital stays needed. The aim of this study was to evaluate surgical palliation via extrahepatic bile duct resection as an option for palliative treatment.
Between 2005 and 2016, we treated 120 pCCC patients with primary palliative care. Three treatment strategies were retrospectively considered: extrahepatic bile duct resection (EBR), exploratory laparotomy (EL), and primary palliative (PP) therapy.
The EBR group required significantly less stenting postoperatively, and the overall morbidity was 29.4% (EBR). After the surgical procedure, fewer subsequent endoscopic treatments for stenting or PTBD were necessary in the EBR group over time. The 30-day mortality was 5.9% (EBR) and 3.4% (EL). The median overall survival averaged 570 (EBR), 392 (EL), and 247 (PP) days.
In selected pCCC patients, palliative extrahepatic bile duct resection is a feasible option for treatment of obstructive cholestasis and should be reconsidered as a therapy option for these patients even in a palliative setting.
不可切除的肝门部胆管癌患者的生存率极差。缓解的一个重要部分是治疗肿瘤引起的阻塞性胆汁淤积。目前，这主要通过内镜下支架或经皮经肝胆管引流（PTBD）来实现，由于需要多次住院，支架需要频繁更换，从而限制了患者的健康相关生活质量。本研究旨在评估经肝外胆管切除术作为姑息治疗的一种选择。
2005 年至 2016 年间，我们对 120 例原发性姑息治疗的 pCCC 患者进行了治疗。回顾性考虑了三种治疗策略：肝外胆管切除术（EBR）、剖腹探查术（EL）和原发性姑息（PP）治疗。
EBR 组术后支架放置次数明显减少，总并发症发生率为 29.4%（EBR）。在 EBR 组中，随着时间的推移，术后需要进行后续内镜治疗以放置支架或 PTBD 的次数较少。30 天死亡率为 5.9%（EBR）和 3.4%（EL）。总生存中位数平均为 570 天（EBR）、392 天（EL）和 247 天（PP）。
在选择的 pCCC 患者中，姑息性肝外胆管切除术是治疗阻塞性胆汁淤积的可行选择，即使在姑息治疗的情况下，也应重新考虑将其作为这些患者的治疗选择。
