术后并发症对于联合大范围肝切除治疗进展期肝门部胆管癌长期预后的影响
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摘要
目的:探讨术后并发症与联合大范围肝切除治疗进展期肝门部胆管癌患者预后的相关性。方法:回顾性分析2008—2017年接受联合大范围肝切除与尾状叶切除术治疗肝门部胆管癌患者的临床资料。术后严重并发症定义为任何Cla-vien-DindoⅢ或Ⅳ级并发症。结果:共123例纳入研究,其中35例(28.5%)出现严重术后并发症。出现严重术后并发症和无严重术后并发症的5年疾病特异性生存率和无复发生存率分别为12.9%vs. 40.2%(P=0.012)、0%vs. 28.1%(P <0.001)。多因素分析显示,严重术后并发症是无复发生存率的独立预测因素(风险比=1.87,P=0.043),但严重术后并发症不是疾病特异性生存率的独立预后因素。根据并发症严重程度分层的亚组分析显示了相似结果,出现轻度术后并发症与无并发症的患者长期生存相近。结论:联合大范围肝切除治疗肝门部胆管术后的严重并发症与患者的不良预后相关。因此,良好的术前准备和精细的手术操作对减少严重术后并发症、提高长期生存非常重要。
Objective:To determine the prognostic relevance of postoperative morbidity in advanced perihilar cholangiocarcinoma(PHC). Methods:From 2008 to 2017,clinical data of patients undergoing major hepatectomy with caudate lobectomy for PHC were reviewed retrospectively. Severe morbidity was defined as any complication of Clavien-Dindo grade Ⅲ or Ⅳ. Results:A total of 123 patients were enrolled and severe morbidity occurred in 35 patients(28.4%). The 5-year disease-specific survival and recurrence-free survival for those with and without severe morbidity were:12.9% versus 40.2%(P=0.012)and 0% versus 28.1%(P < 0.001),respectively. Multivariate analysis revealed that severe morbidity independently predicted decreased recurrence-free survival(hazard ratio=1.87,P=0.043);however,severe morbidity did not emerge as an independent predictor of disease-specific survival. Subgroup analysis of patients stratified by morbidity grade showed similar results,while patients with minor morbidity showed similar survival to those without morbidity. Conclusion:Severe morbidity adversely affects survival outcomes following major liver resection for PHC;thus,optimal preoperative preparation and careful dissection are important to reduce postoperative complications and improve long-term survival.
Objective:To determine the prognostic relevance of postoperative morbidity in advanced perihilar cholangiocarcinoma(PHC). Methods:From 2008 to 2017,clinical data of patients undergoing major hepatectomy with caudate lobectomy for PHC were reviewed retrospectively. Severe morbidity was defined as any complication of Clavien-Dindo grade Ⅲ or Ⅳ. Results:A total of 123 patients were enrolled and severe morbidity occurred in 35 patients(28.4%). The 5-year disease-specific survival and recurrence-free survival for those with and without severe morbidity were:12.9% versus 40.2%(P=0.012)and 0% versus 28.1%(P < 0.001),respectively. Multivariate analysis revealed that severe morbidity independently predicted decreased recurrence-free survival(hazard ratio=1.87,P=0.043);however,severe morbidity did not emerge as an independent predictor of disease-specific survival. Subgroup analysis of patients stratified by morbidity grade showed similar results,while patients with minor morbidity showed similar survival to those without morbidity. Conclusion:Severe morbidity adversely affects survival outcomes following major liver resection for PHC;thus,optimal preoperative preparation and careful dissection are important to reduce postoperative complications and improve long-term survival.
引文
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[16]Kitano Y,Okabe H,Yamashita YI,et al.Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma[J].Br J Cancer,2018,118(2):171-180
[17]Choi J,Ghoz HM,Peeraphatdit T,et al.Aspirin use and the risk of cholangiocarcinoma[J].Hepatology,2016,64(3):785-796
[18]Farges O,Regimbeau JM,Fuks D,et al.Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma[J].Br J Surg,2013,100(2):274-283
[2]Poruk KE,Pawlik TM,Weiss MJ.Perioperative management of hilar cholangiocarcinoma[J].J Gastrointest Surg,2015,19(10):1889-1899
[3]Kang MJ,Jang JY,Chang J,et al.Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma[J].World J Surg,2016,40(10):2451-2459
[4]Agrawal S,Belghiti J.Oncologic resection for malignant tumors of the liver[J].Ann Surg,2011,253(4):656-665
[5]Doussot A,Lim C,Gómez-Gavara C,et al.Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma[J].Br J Surg,2016,103(13):1887-1894
[6]李建伟,王树生,郭科.围术期并发症对大肠癌肝脏转移患者预后的影响[J].南京医科大学学报(自然科学版),2017,37(1):98-100
[7]Doussot A,Lim C,Lahat E,et al.Complications after hepatectomy for hepatocellular carcinoma independently shorten survival:A western,single-center audit[J].Ann Surg Oncol,2017,24(6):1569-1578
[8]Ji GW,Zhu FP,Wang K,et al.Clinical implications of biliary confluence pattern for bismuth-corlette typeⅣhilar cholangiocarcinoma applied to hemihepatectomy[J].JGastrointest Surg,2017,21(4):666-675
[9]Bismuth H,Nakache R,Diamond T.Management strategies in resection for hilar cholangiocarcinoma[J].Ann Surg,1992,215(1):31-38
[10]毛谅,陈骏,孙士全,等.美国癌症联合委员会肝门部胆管癌分期系统(第8版)更新解读[J].中国实用外科杂志,2017,37(5):510-513
[11]Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J].Ann Surg,2004,240(2):205-213
[12]Ebata T,Mizuno T,Yokoyama Y,et al.Surgical resection for Bismuth typeⅣperihilar cholangiocarcinoma[J].Br J Surg,2018,105(7):829-838
[13]Kimura N,Young AL,Toyoki Y,et al.Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers:Outcome analysis and prognostic factors[J].Surgery,2017,162(3):500-514
[14]Schreiber RD,Old LJ,Smyth MJ.Cancer immunoediting:integrating immunity’s roles in cancer suppression and promotion[J].Science,2011,331(6024):1565-1570
[15]Mansour JC,Aloia TA,Crane CH,et al.Hilar cholangiocarcinoma:expert consensus statement[J].HPB(Oxford),2015,17(8):691-699
[16]Kitano Y,Okabe H,Yamashita YI,et al.Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma[J].Br J Cancer,2018,118(2):171-180
[17]Choi J,Ghoz HM,Peeraphatdit T,et al.Aspirin use and the risk of cholangiocarcinoma[J].Hepatology,2016,64(3):785-796
[18]Farges O,Regimbeau JM,Fuks D,et al.Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma[J].Br J Surg,2013,100(2):274-283
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