Kokumai Takashi, Aoki Shuichi, Nakagawa Kei, Iseki Masahiro, Sato Hideaki, Miura Takayuki, Maeda Shimpei, Ishida Masaharu, Mizuma Masamichi, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Hepatobiliary Pancreat Sci. 2025 Apr;32(4):298-310. doi: 10.1002/jhbp.12111. Epub 2025 Feb 13.
Hemihepatectomy with extrahepatic bile duct resection is considered the only curative treatment for perihilar cholangiocarcinoma. The aim of the study was to clarify the survival benefits in this invasive surgical procedure for elderly patients.
A total of 290 patients who underwent surgical resection for perihilar cholangiocarcinoma in our department from 2000 to 2020 were categorized into the E group (62 patients aged ≥75 years) and NE group (228 patients aged <74 years).
The E group exhibited decreased pathological lymph node metastasis (p = .001) and had a shorter operative time (p = .021) and fewer cases of combined vascular resection (p = .002). We found no significant differences in postoperative mortality; however, disease-specific survival was significantly better in the E group (3-year survival: 75.6 vs. 60.3%, p = .031). After propensity score matching, overall survival and disease-specific survival did not differ between the two groups; nevertheless, the hospital mortality rate was significantly higher in the E group (11.5 vs. 1.6%, p = .020). In the E group, a high preoperative Glasgow prognostic score was the only factor associated with hospital mortality (odds ratio, 7.35; p = .026) and indicated worse prognosis.
A high preoperative Glasgow prognostic score was associated with hospital mortality and poor prognosis in elderly patients with perihilar cholangiocarcinoma.
肝外胆管切除的半肝切除术被认为是肝门部胆管癌的唯一根治性治疗方法。本研究的目的是阐明这种侵入性手术对老年患者的生存益处。
2000年至2020年在我科接受肝门部胆管癌手术切除的290例患者被分为E组（62例年龄≥75岁）和NE组（228例年龄<74岁）。
E组病理淋巴结转移减少（p = 0.001），手术时间较短（p = 0.021），联合血管切除病例较少（p = 0.002）。我们发现术后死亡率无显著差异；然而，E组的疾病特异性生存率显著更好（3年生存率：75.6%对60.3%，p = 0.031）。倾向评分匹配后，两组的总生存率和疾病特异性生存率无差异；尽管如此，E组的医院死亡率显著更高（11.5%对1.6%，p = 0.020）。在E组中，术前高格拉斯哥预后评分是与医院死亡率相关的唯一因素（比值比，7.35；p = 0.026），并表明预后较差。
术前高格拉斯哥预后评分与肝门部胆管癌老年患者的医院死亡率和不良预后相关。
