Division of Gastroenterology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.
Department of Internal Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea.
Langenbecks Arch Surg. 2023 Jun 8;408(1):229. doi: 10.1007/s00423-023-02965-7.
BACKGROUND/OBJECTIVES: Bismuth type IV perihilar cholangiocarcinoma has been considered an unresectable disease. The aim of the study was to assess whether the surgical resection of type IV perihilar cholangiocarcinoma was associated with better survival rates.
The data of 117 patients diagnosed with type IV perihilar cholangiocarcinoma at Keimyung University Dongsan Hospital from 2005 to 2020 were retrospectively reviewed. The Bismuth type was assigned based on the patient's radiological imaging findings. The primary outcomes were the surgical results and median overall survival.
The demographic characteristics of the 117 patients with type IV perihilar cholangiocarcinoma were comparable between the surgical resection and non-resection groups. Thirty-two (27.4%) patients underwent surgical resections. A left hepatectomy was performed in 16 patients, right hepatectomy in 13 patients, and a central bi-sectionectomy in three patients. The remaining 85 patients received non-surgical treatments. Thirteen (10.9%) received palliative chemotherapy, and 72 (60.5%) patients received conservative treatment including biliary drainage. The patients in the resection group showed significantly longer median overall survival than the patients in the non-resection group (32.4 vs 16.0 months; P = 0.002), even though the positive resection margin rate was high (62.5%). Surgical complications occurred in 15 (46.9%) patients. Complications of Clavien-Dindo classification grade III or higher occurred in 13 (40.6%) patients and grade V in two patients (6.3%).
Surgical resection for Bismuth type IV perihilar cholangiocarcinoma is technically demanding. The survival of the resection group was significantly better than that of the non-resection group. The resection of selected patients achieved a curative goal with acceptable postoperative morbidity, although the microscopically positive resection margin rate was high.
背景/目的：铋Ⅳ型肝门部胆管癌被认为是一种不可切除的疾病。本研究旨在评估外科切除Ⅳ型肝门部胆管癌是否与更好的生存率相关。
回顾性分析 2005 年至 2020 年期间在启明大学东山医院诊断为Ⅳ型肝门部胆管癌的 117 例患者的数据。根据患者的影像学检查结果分配铋分型。主要结局为手术结果和中位总生存期。
117 例Ⅳ型肝门部胆管癌患者的人口统计学特征在手术切除组和非手术切除组之间无差异。32 例（27.4%）患者接受了手术切除。16 例行左半肝切除术，13 例行右半肝切除术，3 例行中央半肝切除术。其余 85 例患者接受非手术治疗。13 例（10.9%）接受姑息性化疗，72 例（60.5%）患者接受包括胆道引流在内的保守治疗。切除组患者的中位总生存期明显长于非切除组（32.4 个月 vs. 16.0 个月；P=0.002），尽管切缘阳性率较高（62.5%）。切除组有 15 例（46.9%）患者发生手术并发症。Clavien-Dindo 分级 Ⅲ级或以上并发症发生 13 例（40.6%），Ⅴ级并发症 2 例（6.3%）。
对铋Ⅳ型肝门部胆管癌进行手术切除具有一定技术难度。切除组的生存率明显优于非切除组。尽管切缘显微镜下阳性率较高，但对选定患者进行切除可达到治愈目的，且术后并发症发生率可接受。
