Lang Hauke, Gröger Lisa-Katharina, Straub Beate K, Huber Tobias, Margies Rabea, Scholz Constantin, Foerster Friedrich, Weinmann Arndt, Oberholzer Katja, Baumgart Janine, Mittler Jens, Bartsch Fabian
Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Eur J Surg Oncol. 2025 Sep;51(9):110193. doi: 10.1016/j.ejso.2025.110193. Epub 2025 May 29.
Major vascular involvement in intrahepatic cholangiocarcinoma (iCCA) is often considered a relative contraindication to resection, resulting in limited data on hepatectomy with vascular resection and reconstruction. This study aimed to assess perioperative and long-term outcomes of hepatectomy combined with vascular resection and reconstruction in a high volume single center. We retrospectively analyzed all patients undergoing surgical exploration for iCCA between 2008 and 2023, with follow-up through January 2025. Data were evaluated for vascular resections involving the portal vein, major hepatic veins, or inferior vena cava, and their impact on outcomes. Among 345 explored patients, 265 (77 %) underwent resection with curative intent; 41 (16 %) required 59 vascular resections with reconstruction. Factors significantly associated with vascular resection included extent of hepatectomy, nodal status, tumor grading, and UICC stage. Vascular invasion was confirmed histologically in 37 % of resected vessels. Ninety-day mortality was higher in the vascular resection group (15 % vs. 6 %), with biliary reconstruction identified as a key mortality risk factor. Median overall survival was 17 months for vascular resection patients versus 25 months without. Recurrence-free survival was similar between groups. Within the vascular resection group, macrovascular invasion was associated with worse survival (11 vs. 25 months). The 5-year survival rate was 20 %, exceeding outcomes of palliative treatment. As only one-third of vascular resections showed confirmed macrovascular invasion, suspected vascular involvement should not be an absolute contraindication to resection. Nonetheless, caution is adviced when hepaticojejunostomy is required. Further studies are needed to assess outcomes following neoadjuvant therapy.
肝内胆管癌（iCCA）中主要血管受累通常被视为手术切除的相对禁忌证，导致关于肝切除联合血管切除与重建的资料有限。本研究旨在评估在一个高手术量的单中心中肝切除联合血管切除与重建的围手术期及长期结局。我们回顾性分析了2008年至2023年间所有因iCCA接受手术探查的患者，并随访至2025年1月。评估了涉及门静脉、主要肝静脉或下腔静脉的血管切除情况及其对结局的影响。在345例接受探查的患者中，265例（77%）进行了根治性切除；41例（16%）需要进行59次血管切除并重建。与血管切除显著相关的因素包括肝切除范围、淋巴结状态、肿瘤分级和国际抗癌联盟（UICC）分期。37%的切除血管经组织学证实有血管侵犯。血管切除组的90天死亡率较高（15%对6%），胆管重建被确定为关键的死亡风险因素。血管切除患者的中位总生存期为17个月，未进行血管切除的患者为25个月。两组间无复发生存期相似。在血管切除组中，大血管侵犯与较差的生存期相关（11个月对25个月）。5年生存率为20%，超过了姑息治疗的结局。由于只有三分之一的血管切除显示有确诊的大血管侵犯，怀疑血管受累不应成为切除的绝对禁忌证。尽管如此，在需要进行肝空肠吻合术时仍建议谨慎操作。需要进一步研究来评估新辅助治疗后的结局。
