Department of General Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, 1 Minde Road, Nanchang, 330006, China.
Department of General Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, 1 Minde Road, Nanchang, 330006, China; Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China.
Eur J Surg Oncol. 2024 Jun;50(6):108339. doi: 10.1016/j.ejso.2024.108339. Epub 2024 Apr 12.
The optimal surgical approach for Bismuth II hilar cholangiocarcinoma (HCCA) remains controversial. This study compared perioperative and oncological outcomes between minor and major hepatectomy.
One hundred and seventeen patients with Bismuth II HCCA who underwent hepatectomy and cholangiojejunostomy between January 2018 and December 2022 were retrospectively investigated. Propensity score matching created a cohort of 62 patients who underwent minor (n = 31) or major (n = 31) hepatectomy. Perioperative outcomes, complications, quality of life, and survival outcomes were compared between the groups. Continuous data are expressed as the mean ± standard deviation, categorical variables are presented as n (%).
Minor hepatectomy had a significantly shorter operation time (245.42 ± 54.31 vs. 282.16 ± 66.65 min; P = 0.023), less intraoperative blood loss (194.19 ± 149.17 vs. 315.81 ± 256.80 mL; P = 0.022), a lower transfusion rate (4 vs. 11 patients; P = 0.038), more rapid bowel recovery (17.77 ± 10.00 vs. 24.94 ± 9.82 h; P = 0.005), and a lower incidence of liver failure (1 vs. 6 patients; P = 0.045). There were no significant between-group differences in wound infection, bile leak, bleeding, pulmonary infection, intra-abdominal fluid collection, and complication rates. Postoperative laboratory values, length of hospital stay, quality of life scores, 3-year overall survival (25.8 % vs. 22.6 %; P = 0.648), and 3-year disease-free survival (12.9 % vs. 16.1 %; P = 0.989) were comparable between the groups.
In this propensity score-matched analysis, overall survival and disease-free survival were comparable between minor and major hepatectomy in selected patients with Bismuth II HCCA. Minor hepatectomy was associated with a shorter operation time, less intraoperative blood loss, less need for transfusion, more rapid bowel recovery, and a lower incidence of liver failure. Besides, this findings need confirmation in a large-scale, multicenter, prospective randomized controlled trial with longer-term follow-up.
对于Ⅱ型肝门部胆管癌（HCCA），最佳的手术入路仍存在争议。本研究比较了小肝切除术和大肝切除术的围手术期和肿瘤学结果。
回顾性分析了 2018 年 1 月至 2022 年 12 月期间接受肝切除术和胆肠吻合术的 117 例Ⅱ型肝门部胆管癌患者。通过倾向评分匹配创建了一个由 62 例患者组成的队列，他们接受了小（n=31）或大（n=31）肝切除术。比较两组患者的围手术期结果、并发症、生活质量和生存结果。连续数据表示为平均值±标准差，分类变量表示为 n（%）。
小肝切除术的手术时间明显更短（245.42±54.31 分钟 vs. 282.16±66.65 分钟；P=0.023），术中出血量更少（194.19±149.17 毫升 vs. 315.81±256.80 毫升；P=0.022），输血率更低（4 例 vs. 11 例；P=0.038），肠道恢复更快（17.77±10.00 小时 vs. 24.94±9.82 小时；P=0.005），肝功能衰竭发生率更低（1 例 vs. 6 例；P=0.045）。两组间在伤口感染、胆漏、出血、肺部感染、腹腔积液和并发症发生率方面无显著差异。术后实验室值、住院时间、生活质量评分、3 年总生存率（25.8% vs. 22.6%；P=0.648）和 3 年无病生存率（12.9% vs. 16.1%；P=0.989）无差异。
在本倾向评分匹配分析中，在选择的Ⅱ型肝门部胆管癌患者中，小肝切除术和大肝切除术的总生存率和无病生存率相当。小肝切除术与手术时间更短、术中失血量更少、输血需求更少、肠道恢复更快、肝功能衰竭发生率更低有关。此外，这些发现需要在具有长期随访的大型、多中心、前瞻性随机对照试验中进一步证实。
