Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Department of Gastroenterology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Ann Surg Oncol. 2024 Jan;31(1):90-96. doi: 10.1245/s10434-023-14406-2. Epub 2023 Oct 29.
Cancer-free resection (R0) is one of the most important factors for the long-term survival of biliary carcinoma. For some patients with widespread invasive cancer located between the hilar and intrapancreatic bile duct, hepatopancreaticoduodenectomy (HPD) is considered a radical surgery for R0 resection. However, HPD is associated with high morbidity and mortality rates. Furthermore, previous reports have not shown lymph node metastasis (LNM) status, such as the location or number, which could influence the prognosis after HPD. In this study, first, we explored the prognostic factors for survival, and second, we evaluated whether the LNM status (number and location of LNM) would influence the decision on surgical indications in patients with widely spread biliary malignancy.
We retrospectively reviewed the medical records of 54 patients who underwent HPD with hepatectomy in ≥2 liver sectors from January 2003 to December 2021 (HPD-G). We also evaluated 54 unresectable perihilar cholangiocarcinoma patients who underwent chemotherapy from January 2010 to December 2021 (CTx-G).
R0 resection was performed in 48 patients (89%). The median survival time (MST) and 5-year overall survival rate of the HPD-G and CTx-G groups were 36.9 months and 31.1%, and 19.6 months and 0%, respectively. Univariate and multivariate analyses showed that pathological portal vein involvement was an independent prognostic factor for survival (MST: 18.9 months). Additionally, patients with peripancreatic LNM had worse prognoses (MST: 13.3 months) than CTx-G.
Patients with peripancreatic LNM or PV invasion might be advised to be excluded from surgery-first indications for HPD.
无癌切缘（R0）是胆管癌长期生存的最重要因素之一。对于一些广泛浸润性癌症位于肝门和胰内胆管之间的患者，肝胰十二指肠切除术（HPD）被认为是 R0 切除的根治性手术。然而，HPD 与较高的发病率和死亡率相关。此外，先前的报告并未显示淋巴结转移（LNM）的状态，例如位置或数量，这可能会影响 HPD 后的预后。在这项研究中，首先，我们探讨了生存的预后因素，其次，我们评估了 LNM 状态（LNM 的数量和位置）是否会影响广泛扩散的胆道恶性肿瘤患者的手术适应证决策。
我们回顾性分析了 2003 年 1 月至 2021 年 12 月期间接受≥2 个肝段肝切除术的 54 例 HPD 患者（HPD-G）的病历。我们还评估了 2010 年 1 月至 2021 年 12 月期间接受化疗的 54 例不可切除的肝门部胆管癌患者（CTx-G）。
R0 切除在 48 例患者（89%）中完成。HPD-G 和 CTx-G 组的中位生存时间（MST）和 5 年总生存率分别为 36.9 个月和 31.1%，19.6 个月和 0%。单因素和多因素分析表明，病理门静脉侵犯是生存的独立预后因素（MST：18.9 个月）。此外，具有胰周淋巴结转移（LNM）的患者预后较差（MST：13.3 个月），与 CTx-G 相比。
具有胰周淋巴结转移或门静脉侵犯的患者可能不适合手术，建议将其排除在 HPD 的手术适应证之外。
