Jin Shuo, Jiang Nan, Zhao Jing-Min, Xiao Ying, Wang Si-Yuan, Xiang Can-Hong, Lu Qian, Shan Si-Qiao, Ruan Hao-Tian, Yu Shao-Qing, Zeng Jian-Ping, Yang Shi-Zhong, Li Li, Dong Jia-Hong
HepatopancreLatobiliary Center, Beijing Tsinghua Changgung Hospital, Key Laboratory of Digital Intelligence Hepatology, Ministry of Education, School of Clinical Medicine, Tsinghua University, Beijing, China.
Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing, China.
Int J Surg. 2025 Jan 1;111(1):31-39. doi: 10.1097/JS9.0000000000002040.
The extent of intrahepatic infiltration of perihilar cholangiocarcinoma (PHCC) remains unclear. This research aimed to explore the pattern and extent of intrahepatic infiltration of PHCC to guide surgical treatment and pathological research.
This study included 62 patients diagnosed with PHCC who underwent major hepatectomy. A whole-mount digital liver pathology system (WDLPS) for hepatectomy specimens greater than 10×10 cm was used to panoramically assess the intrahepatic infiltration extent of PHCC.
The distal intrahepatic infiltration (DIHI) and radial liver invasion (RLI) were important parts of intrahepatic infiltration for PHCC explored by WDLPS. The study confirmed that 75.8% of PHCCs had RLI and the infiltration distance in all patients were within 15 000 µm, 62.9% of PHCCs had DIHI greater than 1 cm away from the main tumor in the liver parenchyma. The recurrence-free survival rates and overall survival rates of patients with DIHI were poorer than the patients without DIHI ( P <0.0001, P =0.0038). Arterial invasion on the resected side could be an excellent predictor. A total of 105 liver lobes were resected from 62 PHCC patients. The invasion rates of the left lateral, left medial, right anterior, and right posterior lobe of PHCC were 79%, 100%, 100%, and 69%, respectively.
The presence of DIHI in most PHCCs was a significant factor for the poor survival. Based on the extent of intrahepatic infiltration, minor hepatectomy was not suitable as the curative surgery for PHCC. Major hepatectomy and liver transplantation were the ideal radical treatment.
肝门部胆管癌（PHCC）肝内浸润范围尚不清楚。本研究旨在探讨PHCC肝内浸润的模式和范围，以指导手术治疗和病理研究。
本研究纳入62例接受大肝切除术的PHCC患者。使用全层数字肝脏病理系统（WDLPS）对大于10×10 cm的肝切除标本进行全景评估，以确定PHCC的肝内浸润范围。
肝内远端浸润（DIHI）和肝脏径向侵犯（RLI）是WDLPS所探索的PHCC肝内浸润的重要部分。研究证实，75.8%的PHCC存在RLI，所有患者的浸润距离均在15000 µm以内，62.9%的PHCC在肝实质内的DIHI距离主肿瘤大于1 cm。DIHI患者的无复发生存率和总生存率低于无DIHI的患者（P<0.0001，P=0.0038）。切除侧的动脉侵犯可能是一个很好的预测指标。62例PHCC患者共切除105个肝叶。PHCC对肝左外叶、左内叶、右前叶和右后叶的侵犯率分别为79%、100%、100%和69%。
大多数PHCC中DIHI的存在是生存不良的重要因素。基于肝内浸润范围，小范围肝切除术不适用于PHCC的根治性手术。大范围肝切除术和肝移植是理想的根治性治疗方法。
