背景:铋II型肝门部胆管癌(HCCA)的最佳手术方法仍存在争议。这项研究比较了小型和大型肝切除术的围手术期和肿瘤学结果。
方法:回顾性调查了2018年1月至2022年12月期间接受肝切除术和胆管空肠吻合术的117例BismuthIIHCCA患者。倾向评分匹配创建了62例接受小(n=31)或大(n=31)肝切除术的患者队列。围手术期结果,并发症,生活质量,并比较两组间的生存结局.连续数据表示为平均值±标准偏差,分类变量表示为n(%)。
结果:小型肝切除术的手术时间明显缩短(245.42±54.31vs.282.16±66.65min;P=0.023),术中出血量少(194.19±149.17vs.315.81±256.80mL;P=0.022),较低的输血率(4vs.11例;P=0.038),更快速的肠道恢复(17.77±10.00vs.24.94±9.82h;P=0.005),和肝衰竭的发生率较低(1vs.6例;P=0.045)。伤口感染的组间差异无统计学意义,胆漏,出血,肺部感染,腹腔积液,和并发症发生率。术后实验室值,住院时间,生活质量分数,3年总生存率(25.8%vs.22.6%;P=0.648),和3年无病生存率(12.9%vs.16.1%;P=0.989)组间具有可比性。
结论:在此倾向得分匹配分析中,在选定的BismuthII型HCCA患者中,小肝切除术和大肝切除术的总生存期和无病生存期具有可比性.小型肝切除术与较短的手术时间有关,术中失血少,不需要输血,更快速的肠道恢复,肝功能衰竭的发生率较低。此外,这一发现需要大规模确认,多中心,前瞻性随机对照试验和长期随访。
BACKGROUND: The optimal surgical approach for Bismuth II hilar cholangiocarcinoma (HCCA) remains controversial. This study compared perioperative and oncological outcomes between minor and major hepatectomy.
METHODS: One hundred and seventeen patients with Bismuth II HCCA who underwent hepatectomy and cholangiojejunostomy between January 2018 and December 2022 were retrospectively investigated. Propensity score matching created a cohort of 62 patients who underwent minor (n = 31) or major (n = 31) hepatectomy. Perioperative outcomes, complications, quality of life, and survival outcomes were compared between the groups. Continuous data are expressed as the mean ± standard deviation, categorical variables are presented as n (%).
RESULTS: Minor hepatectomy had a significantly shorter operation time (245.42 ± 54.31 vs. 282.16 ± 66.65 min; P = 0.023), less intraoperative blood loss (194.19 ± 149.17 vs. 315.81 ± 256.80 mL; P = 0.022), a lower transfusion rate (4 vs. 11 patients; P = 0.038), more rapid bowel recovery (17.77 ± 10.00 vs. 24.94 ± 9.82 h; P = 0.005), and a lower incidence of liver failure (1 vs. 6 patients; P = 0.045). There were no significant between-group differences in wound infection, bile leak, bleeding, pulmonary infection, intra-abdominal fluid collection, and complication rates. Postoperative laboratory values, length of hospital stay, quality of life scores, 3-year overall survival (25.8 % vs. 22.6 %; P = 0.648), and 3-year disease-free survival (12.9 % vs. 16.1 %; P = 0.989) were comparable between the groups.
CONCLUSIONS: In this propensity score-matched analysis, overall survival and disease-free survival were comparable between minor and major hepatectomy in selected patients with Bismuth II HCCA. Minor hepatectomy was associated with a shorter operation time, less intraoperative blood loss, less need for transfusion, more rapid bowel recovery, and a lower incidence of liver failure. Besides, this findings need confirmation in a large-scale, multicenter, prospective randomized controlled trial with longer-term follow-up.