Ann Surg:联合血管切除术治疗局部晚期肝门部胆管癌

2020-09-29 MedSci原创 MedSci原创

肝门部胆管癌(PHC)也称Klatskin瘤,是胆道系统常见的恶性肿瘤。肝门部胆管癌因其发生部位特殊、呈浸润性生长及与肝门部血管关系密切等特点给手术切除造成极大的困难。长期以来,肝门部胆管癌被认为是无

肝门部胆管癌(PHC)也称Klatskin瘤,是胆道系统常见的恶性肿瘤。肝门部胆管癌因其发生部位特殊、呈浸润性生长及与肝门部血管关系密切等特点给手术切除造成极大的困难。长期以来,肝门部胆管癌被认为是无法手术根治性切除的癌肿。

近20年来,随着影像学和手术技术的进步,使肝门部胆管癌的诊断和治疗取得重大进步,手术切除率逐步提高,生存率得到明显改善。

肝切除联合门静脉切除(PVR)和/或肝动脉切除(HAR)技术要求高,但仅适用于累及肝门入肝血管的PHC的根治方案;然而,其有效性和安全性尚未明确的评估数据。

本研究旨在评估联合血管切除术(VR)治疗晚期肝门部胆管癌(PHC)的疗效和安全性。

纳入2001-2018年诊断为PHC的患者。根据患者是否采用联合VR手术将进行手术治疗的患者分组,并将接受VR手术的患者按VR类型进一步细分。比较不同患者组的术后结果和总体存活期(OS)。

在1055例患者中,787例(75%)行手术切除(无VR:484例,PVR:157例,HAR:146例)。术后并发症和死亡率分别为49%(无VR组 vs VR组:48% vs 50%;P=0.715)和2.1%(1.2% vs 3.6%;P=0.040)。行VR切除患者的OS(中位数30个月)明显短于行非VR手术的患者(61个月;P<0.0001),但长于未手术者(10个月;P<0.0001)。接受PVR或HAR的患者的OS无显著性差异(中位数分别为29个月和34个月;P=0.517)。

综上,VR挽救了大量不能手术切除的局部晚期PHC患者,因此,如果肝门部流入血管是可重建的,则推荐使用VR,有望改善患者预后,带来显著的生存效益。

原始出处:

Mizuno Takashi,Ebata Tomoki,Yokoyama Yukihiro et al. Combined Vascular Resection for Locally Advanced Perihilar Cholangiocarcinoma. Ann. Surg., 2020.

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    2020-10-01 chg122
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    2020-09-29 ms1000000672797977

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