Poletto Edoardo, Olthof Pim B, Hoogwater Frederik J H, Erdmann Joris I, Schnitzbauer Andreas A, Sparrelid Ernesto, Maithel Shishir K, Dopazo Cristina, Hakeem Abdul R, Ratti Francesca, Ruzzenente Andrea, Groot Koerkamp Bas
Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy.
Division of Hepato-Pancreato-Biliary Surgery and Transplantation, Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands.
Ann Surg Oncol. 2025 Sep 13. doi: 10.1245/s10434-025-18137-4.
Hepatectomy with associated vascular resection and reconstruction (VR) is an option to increase the number of patients with locally advanced perihilar cholangiocarcinoma (pCCA) eligible for radical-intent surgery.
This study aimed to assess the safety and oncological outcomes of VR in pCCA patients.
Patients who underwent surgery for pCCA at 10 western centers were retrospectively reviewed and divided according to the performance of the VR. Primary outcomes were major morbidity, vascular morbidity, 90-day mortality, and overall survival (OS).
A total of 1054 patients were included, of whom 259 (24.6%) underwent VR. Of these 259 patients, 199 (76.8 %) underwent portal vein reconstruction (PVR) only and 60 (23.2%) underwent hepatic artery reconstruction (HAR) with or without PVR. VR patients were younger (66 vs. 68 years; p = 0.011) and more frequently had Bismuth type 4 tumors (31.3% vs. 22.9%; p = 0.008). They more frequently underwent portal vein embolization (32.0% vs. 17.6%; p < 0.001), biliary drainage (84.9% vs. 77.3%; p = 0.008), and extended hepatectomy (56.8% vs. 37.1%; p < 0.001), with longer operative times (539 vs. 479 min; p < 0.001) and higher blood loss (1300 vs. 700 mL; p < 0.001). Positive resection margins were observed more frequently (45.7% vs. 35.2%; p = 0.003). Major complications (51.4% vs. 41.0%; p = 0.004), vascular complications (19.7% vs. 3.3%; p < 0.001), and mortality (16.2% vs. 10.6%; p = 0.02) were higher in VR patients. Median OS was 28.0 months for patients without VR versus 22.8 months for patients with VR (p = 0.18).
Liver resection and VR in patients with locally advanced pCCA are associated with increased major and vascular morbidity but offer similar survival as patients not undergoing VR; therefore, VR should be considered in selected patients.
肝切除联合血管切除与重建（VR）是一种增加局部晚期肝门部胆管癌（pCCA）患者接受根治性手术机会的选择。
本研究旨在评估VR在pCCA患者中的安全性和肿瘤学结局。
对10家西方中心接受pCCA手术的患者进行回顾性分析，并根据是否进行VR进行分组。主要结局指标为严重并发症、血管并发症、90天死亡率和总生存期（OS）。
共纳入1054例患者，其中259例（24.6%）接受了VR。在这259例患者中，199例（76.8%）仅接受了门静脉重建（PVR），60例（23.2%）接受了肝动脉重建（HAR），伴或不伴PVR。接受VR的患者更年轻（66岁对68岁；p = 0.011），且更频繁地出现Bismuth 4型肿瘤（31.3%对22.9%；p = 0.008）。他们更频繁地接受门静脉栓塞（32.0%对17.6%；p < 0.001）、胆道引流（84.9%对77.3%；p = 0.008）和扩大肝切除术（56.8%对37.1%；p < 0.001），手术时间更长（539分钟对479分钟；p < 0.001），失血量更多（1300毫升对700毫升；p < 0.001）。切缘阳性的情况更常见（45.7%对35.2%；p = 0.003）。VR患者的严重并发症（51.4%对41.0%；p = 0.004）、血管并发症（19.7%对3.3%；p < 0.001）和死亡率（16.2%对10.6%；p = 0.02）更高。未接受VR的患者中位OS为28.0个月，接受VR的患者为22.8个月（p = 0.18）。
局部晚期pCCA患者的肝切除和VR与严重并发症和血管并发症增加相关，但与未接受VR的患者生存率相似；因此，应在特定患者中考虑VR。
