Department of Surgery, Kurume University School of Medicine.
Division of Gastroeterology, Kurume University School of Medicine.
Kurume Med J. 2023 Jul 3;68(2):81-89. doi: 10.2739/kurumemedj.MS682002. Epub 2023 Mar 31.
Distal bile duct carcinoma continues to be one of the most difficult cancers to manage in terms of staging and radical resection. Pancreaticoduodenectomy (PD) with regional lymph node dissection has become the standard treatment of distal bile duct carcinoma. We evaluated treatment outcomes and histological factors in patients with distal bile duct carcinoma.
Seventy-four cases of resection of carcinoma of the distal bile ducts treated at our department during the period from January 2002 and December 2016 using PD and regional lymph node dissection as the standard surgical procedure were investigated. Survival rates of factors were analyzed using uni- and multivariate analyses.
The median survival time was 47.8 months. On univariate analysis, age of 70 years or older, histologically pap, pPanc2,3, pN1, pEM0, v2,3, ly2,3, ne2,3 and postoperative adjuvant chemotherapy were statistically significant factors. On multivariate analysis, histologically pap was identified as a significant independent prognostic factor. The multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as showing a significant trend towards independent prognostic relevance.
The good news about resected distal bile duct carcinoma is that the percentage of those who achieved R0 resection has risen to 89.1%. Our multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as prognostic factors. In order to improve the outcome of treatment, it is necessary to improve preoperative diagnostic imaging of pancreatic invasion and lymph node metastasis, establish the optimal operation range and clarify whether aortic lymph node dissection is needed to control lymph node metastasis, and establish effective regimens of chemotherapy.
远端胆管癌在分期和根治性切除方面仍然是最难治疗的癌症之一。胰十二指肠切除术（PD）加区域淋巴结清扫已成为远端胆管癌的标准治疗方法。我们评估了远端胆管癌患者的治疗结果和组织学因素。
回顾性分析 2002 年 1 月至 2016 年 12 月期间我科采用 PD 加区域淋巴结清扫作为标准手术治疗的 74 例远端胆管癌患者的临床资料。采用单因素和多因素分析方法分析各因素的生存率。
中位生存时间为 47.8 个月。单因素分析显示，年龄≥70 岁、组织学上为 pap、pPanc2,3、pN1、pEM0、v2,3、ly2,3、ne2,3 和术后辅助化疗是统计学上显著的预后因素。多因素分析显示，组织学上为 pap 是独立的预后因素。多因素分析还发现，年龄≥70 岁、pEM0、ne2,3 和术后辅助化疗有独立预后意义的趋势。
好消息是，接受根治性切除术的远端胆管癌患者的比例已上升至 89.1%。我们的多因素分析确定年龄≥70 岁、pEM0、ne2,3 和术后辅助化疗是预后因素。为了提高治疗效果，有必要改善术前对胰腺侵犯和淋巴结转移的诊断成像，确定最佳手术范围，明确是否需要主动脉淋巴结清扫以控制淋巴结转移，并建立有效的化疗方案。
