BackgroundThe benefits of anatomic resection (AR) vs. non-anatomic resection (NAR) in patients with primary intrahepatic cholangiocarcinoma (ICC) with hepatolithiasis (HICC) are unclear. This study aimed to compare the long-term outcomes of AR vs. NAR in patients with HICC.MethodsA total of 147 consecutive patients with HICC who underwent R0 hepatectomy were included. Overall survival (OS) and recurrence-free survival (RFS) following AR vs. NARs were compared using a 1:1 propensity score matching (PSM) analysis. A subgroup analysis was also conducted according to whether there are lymph node metastases (LNM).ResultsIn a multivariate analysis, CA 19-9 (>39 U/L), microvascular invasion, LNM, and NAR were independent risk factors for poor RFS and OS rates, whereas multiple tumors were independent risk factors for OS. AR had better 1-, 3-, and 5-year RFS and OS rates than NAR (OS: 78.7, 58.9, and 28.5%, respectively, vs. 61.2, 25.4, and 8.8%, respectively; RFS: 59.5, 36.5, and 20.5%, respectively, vs. 38.2, 12.1, and 6.9%, respectively). After PSM, 100 patients were enrolled. The NAR group also had significantly poorer OS and RFS (OS: 0.016; RFS: p = 0.010) than the AR group. The subgroup analysis demonstrated that in HICC without LNM, OS and RFS were significantly poorer in the NAR group than the AR group, while no significant differences were observed in HICC with LNM before or after PSM.ConclusionAnatomic resection was associated with better long-term survival outcomes than NAR in patients with HICC, except for patients with LNM.

中文翻译：

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肝内胆管癌合并肝胆管结石的解剖切除与非解剖切除的长期结果：一项多中心回顾性研究

背景 解剖切除术 (AR) 与非解剖切除术 (NAR) 对原发性肝内胆管癌 (ICC) 合并肝胆管结石 (HICC) 患者的益处尚不清楚。本研究旨在比较 AR 与 NAR 在 HICC 患者中的长期结果。方法共纳入 147 名连续接受 R0 肝切除术的 HICC 患者。使用 1:1 倾向评分匹配 (PSM) 分析比较 AR 与 NAR 后的总生存期 (OS) 和无复发生存期 (RFS)。还根据是否存在淋巴结转移（LNM）进行亚组分析。结果在多变量分析中，CA 19-9（>39 U/L）、微血管侵犯、LNM 和 NAR 是 RFS 差的独立危险因素和 OS 率，而多发肿瘤是 OS 的独立危险因素。AR 最好是 1-, 3-, 和 5 年 RFS 和 OS 率高于 NAR（OS：分别为 78.7、58.9 和 28.5%，分别与 61.2、25.4 和 8.8%；RFS：分别为 59.5、36.5 和 20.5%，与 38.2 、12.1 和 6.9%）。PSM 后，有 100 名患者入组。NAR 组的 OS 和 RFS 也明显较差（OS：0.016；RFS：p= 0.010) 比 AR 组。亚组分析表明，在没有 LNM 的 HICC 中，NAR 组的 OS 和 RFS 明显差于 AR 组，而在 PSM 前后有 LNM 的 HICC 中没有观察到显着差异。结论解剖切除与更好的长期生存相关除 LNM 患者外，HICC 患者的结果优于 NAR。