Gundogdu Adnan, Kodalak Taha Anil, Kucukaslan Hakan, Topaloglu Serdar, Turali Ummuhan, Oguz Sukru, Dohman Davut, Dinc Hasan, Ozdemir Feyyaz, Arslan Mehmet, Cobanoglu Umit, Karabulut Erdem, Calik Adnan, Ozturk Mehmet Halil
Department of Surgery, Karadeniz Technical University School of Medicine, Trabzon, Türkiye.
Department of Pathology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye.
Turk J Gastroenterol. 2024 Nov 11;36(1):34-44. doi: 10.5152/tjg.2024.24301.
BACKGROUND/AIMS: Treatment of perihilar cholangiocarcinoma (PHCC) and intrahepatic cholangiocarcinoma (IHCC) is a challenging issue. We aimed to investigate the clinical characteristics of both tumors and the outcome of our treatment policy.
We retrospectively analyzed data of 117 patients who were diagnosed with PHCC or IHCC between January 2007 and September 2023. Postoperative outcomes and the effects of prognostic factors on overall survival (OS) were investigated.
Surgical resection was performed on 47 patients (PHCC, n = 33 and IHCC, n = 14). Preoperative biliary drainage was applied in 32 of 33 cases with PHCC and 2 of 14 cases with IHCC. The mortality rate was 8.5% (n = 4). The complication rate was 68.1%. The R0 resection rate was 73% in PHCC. The mean OS time of PHCC cases that underwent R0 resection was 26.5 ± 24.8 months. The mean OS time of patients who underwent resection for IHCC was 28.7 ± 35.5 months. The OS was poorly affected by high CA19-9 levels (≥37 U/mL) (P = .005), the presence of lymphovascular invasion (P = .049), positive surgical margins after resection (P < .001), and the development of postoperative acute renal failure (P = .078). The OS of patients receiving adjuvant chemotherapy was significantly longer (P = .071). CA19-9 levels of more than 37 U/mL (P = .027) and positive surgical margin (P < .001) were independent factors for poor OS.
Surgical resection is the mainstay of multidisciplinary treatment for PHCC and IHCC. In advanced stages of IHCC, the combination of loco-regional therapies and repeat surgery, along with the enhanced efficacy of systemic chemotherapy, plays a significant role in a patient's survival.
背景/目的：肝门部胆管癌（PHCC）和肝内胆管癌（IHCC）的治疗是一个具有挑战性的问题。我们旨在研究这两种肿瘤的临床特征以及我们治疗策略的结果。
我们回顾性分析了2007年1月至2023年9月期间被诊断为PHCC或IHCC的117例患者的数据。研究了术后结果以及预后因素对总生存期（OS）的影响。
47例患者接受了手术切除（PHCC，n = 33；IHCC，n = 14）。33例PHCC患者中有32例以及14例IHCC患者中有2例进行了术前胆道引流。死亡率为8.5%（n = 4）。并发症发生率为68.1%。PHCC的R0切除率为73%。接受R0切除的PHCC病例的平均OS时间为26.5±24.8个月。接受IHCC切除的患者的平均OS时间为28.7±35.5个月。高CA19-9水平（≥37 U/mL）（P = .005）、存在淋巴管侵犯（P = .049）、切除后手术切缘阳性（P < .001）以及术后急性肾衰竭的发生（P = .078）对OS影响较小。接受辅助化疗的患者的OS明显更长（P = .071）。CA19-9水平超过37 U/mL（P = .027）和手术切缘阳性（P < .001）是OS不良的独立因素。
手术切除是PHCC和IHCC多学科治疗的主要手段。在IHCC的晚期阶段，局部区域治疗与重复手术相结合，以及全身化疗疗效的提高，对患者的生存起着重要作用。
