Journal of Gastrointestinal Surgery ( IF 3.2 ) Pub Date : 2021-06-15 , DOI: 10.1007/s11605-021-05049-3 Xu-Feng Zhang 1, 2 , Nan Zhang 1 , Diamantis I Tsilimigras 2 , Sharon M Weber 3 , George Poultsides 4 , Ioannis Hatzaras 5 , Ryan C Fields 6 , Jin He 7 , Charles Scoggins 8 , Kamron Idrees 9 , Perry Shen 10 , Shishir K Maithel 11 , Timothy M Pawlik 2
Background
The surgical approach to treat Bismuth type I and II hilar cholangiocarcinoma (HCCA) has been a topic of debate. We sought to characterize whether bile duct resection (BDR) with or without concomitant hepatic resection (HR) was associated with R0 margin status, as well as define the impact of HR+BDR versus BDR alone on long-term survival.
Methods
Patients who underwent curative-intent HR+BDR for HCCA between 2000 and 2014 were identified from a multi-institutional database. Perioperative and long-term outcomes were compared among patients who underwent BDR only, BDR+left hepatic resection (LHR), and BDR+right hepatic resection (RHR) for Bismuth type I and II HCCA.
Results
Among 257 patients with HCCA, 61 (23.7%) patients had a Bismuth type I (n=25, 41.0%) or II (n=36, 59.0%) lesion. The incidence of R0 resection after BDR only was the same as among patients after LHR and RHR (BDR 70.0% vs. BDR+LHR 71.4% vs. BDR+RHR 76.5%, p=0.891). In contrast, severe complications were more likely after LHR and RHR than BDR only (BDR 21.4% vs. BDR+LHR 60.0% and BDR+RHR 50.0%, p=0.041). Overall (median: BDR 20.9 vs. BDR+LHR 23.2 and BDR+RHR 25.0 months, p=0.213) and recurrence-free (median: BDR 13.4 vs. BDR+LHR 15.3 and BDR+RHR 25.0, p= 0.109) survival were comparable. On multivariable analysis, while CA19-9>37.0U/ml (Ref. CA19-9≤37.0U/ml, HR 3.2, 95% CI 1.1–9.4, p=0.035) and AJCC T3-T4 disease (Ref. T1-T2, HR 4.6, 95% CI 1.5–13.7, p=0.007) were associated with long-term survival, surgical approach was not (BDR+LHR: HR 1.0, 95% CI 0.5–2.2, p=0.937; BDR+RHR: HR 0.6, 95% CI 0.3–1.3, p=0.197).
Conclusion
R0 resection, overall survival, and recurrence-free survival were comparable among well-selected patients who had BDR versus BDR+HR for Bismuth type I and II HCCA.
中文翻译:
Bismuth I 型和 II 型肺门胆管癌的手术策略:对长期结果的影响
背景
Bismuth I 型和 II 型肝门胆管癌 (HCCA) 的手术方法一直是一个争论的话题。我们试图描述胆管切除术 (BDR) 伴或不伴肝切除术 (HR) 是否与 R0 边缘状态相关,并确定 HR+BDR 与单独 BDR 对长期生存的影响。
方法
从多机构数据库中确定了在 2000 年至 2014 年间因 HCCA 接受治愈性 HR+BDR 的患者。比较了仅接受 BDR、BDR+左肝切除 (LHR) 和 BDR+右肝切除 (RHR) 治疗 Bismuth I 型和 II 型 HCCA 的患者的围手术期和长期结局。
结果
在 257 名 HCCA 患者中,61 名 (23.7%) 患者有铋 I 型 (n=25, 41.0%) 或 II (n=36, 59.0%) 病变。仅 BDR 后 R0 切除的发生率与 LHR 和 RHR 后的患者相同(BDR 70.0% vs. BDR+LHR 71.4% vs. BDR+RHR 76.5%,p = 0.891)。相比之下,LHR 和 RHR 比仅 BDR 后更容易出现严重并发症(BDR 21.4% vs. BDR+LHR 60.0% 和 BDR+RHR 50.0%,p = 0.041)。总体(中位数:BDR 20.9 vs. BDR+LHR 23.2 和 BDR+RHR 25.0 个月,p = 0.213)和无复发(中位数:BDR 13.4 vs. BDR+LHR 15.3 和 BDR+RHR 25.0,p = 0.109)生存率为可比。在多变量分析中,CA19-9>37.0U/ml (Ref. CA19-9≤37.0U/ml, HR 3.2, 95% CI 1.1–9.4, p= 0.035) 和 AJCC T3-T4 疾病 (Ref. T1-T2, HR 4.6, 95% CI 1.5-13.7, p = 0.007) 与长期生存相关,而手术方法与长期生存无关 (BDR+LHR: HR 1.0, 95% CI 0.5–2.2,p = 0.937;BDR+RHR:HR 0.6,95% CI 0.3–1.3,p = 0.197)。
结论
对于 Bismuth I 型和 II 型 HCCA,R0 切除、总生存期和无复发生存期在 BDR 与 BDR+HR 患者中具有可比性。