背景:本研究的目的是调查接受根治性切除肝内胆管癌(ICC)的患者的短期和长期结果,这些结果是根据肝切除程度相对于整体最终病理边缘状态分层的。
方法:从多机构数据库中确定了2000名接受根治性切除的ICC患者。人口统计,临床病理,和操作数据,比较了倾向评分匹配前后接受大切除和小切除的患者的总体生存期(OS)和无复发生存期(RFS).
结果:总体而言,608例(59.4%)患者接受了肝切除术,而415(40.6%)进行了少量切除。大型肝切除术在患有大型肝切除术的患者中更为常见,多个,和双叶肿瘤。大约一半的患者(n=294,48.4%)在肝切除术后发生术后并发症,而在小切除术后只有四分之一的患者(n=113,27.2%)(p<0.001)。在倾向模型中,接受大肝切除术的患者与接受小肝切除术的患者的OS和RFS相等(中位OS,38vs.37个月,p=0.556;和中位数RFS,20vs.18个月,p=0.635)。接受大切除术的患者具有相当的OS和RFS,手术边缘宽(≥10和5-9mm),但在倾向模型中,当手术切缘狭窄(1-4mm)时,与小切除相比,RFS得到改善。在Cox回归模型中,肿瘤特征和手术切缘与长期预后独立相关.
结论:ICC大肝切除术与总生存获益无关,然而与围手术期发病率增加相关.边距宽度,而不是切除的程度,影响长期结果。如果可以达到≥5mm的边缘间隙,则应主张进行根治性保留实质切除术。
BACKGROUND: The objective of the current study was to investigate both short- and long-term outcomes of patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) stratified by extent of hepatic resection relative to overall final pathological margin status.
METHODS: One thousand twenty-three patients with ICC who underwent curative-intent resection were identified from a multi-institutional database. Demographic, clinicopathological, and operative data, as well as overall (OS) and recurrence-free survival (RFS) were compared among patients undergoing
major and minor resection before and after propensity score matching.
RESULTS: Overall, 608 (59.4%) patients underwent
major hepatectomy, while 415 (40.6%) had a minor resection. Major hepatectomy was more frequently performed among patients who had large, multiple, and bilobar tumors. Roughly half of patients (n = 294, 48.4%) developed a postoperative complication following major hepatectomy versus only one fourth of patients (n = 113, 27.2%) after minor resection (p < 0.001). In the propensity model, patients who underwent
major hepatectomy had an equivalent OS and RFS versus patients who had a minor hepatectomy (median OS, 38 vs. 37 months, p = 0.556; and median RFS, 20 vs. 18 months, p = 0.635). Patients undergoing
major resection had comparable OS and RFS with wide surgical margin (≥10 and 5-9 mm), but improved RFS when surgical margin was narrow (1-4 mm) versus minor resection in the propensity model. In the Cox regression model, tumor characteristics and surgical margin were independently associated with long-term outcome.
CONCLUSIONS: Major hepatectomy for ICC was not associated with an overall survival benefit, yet was associated with increased perioperative morbidity. Margin width, rather than the extent of resection, affected long-term outcomes. Radical parenchymal-sparing resection should be advocated if a margin clearance of ≥5 mm can be achieved.