Impact of portal vein resection on聽oncologic long-term outcome in聽patients with hilar cholangiocarcinoma

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• 作者：Katrin Hoffmann ; MD^a ; Stephan Luible ; MD^a ; Benjamin Goeppert ; MD^b ; Karl-Heinz Weiss ; MD^c ; Ulf Hinz ; MSc^a ; Markus W. Bü ; chler ; MD^a ; ^{markus.buechler@med.uni-heidelberg.de" class="auth_mail" title="E-mail the corresponding author} ; Peter Schemmer ; MD^a
• 刊名：Surgery
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：158
• 期：5
• 页码：1252-1260
• 全文大小：221 K

文摘

Liver resection (LR) for hilar cholangiocarcinoma (HCA) remains challenging because of the occurrence of unanticipated vascular and longitudinal bile duct invasion. Operative strategies to achieve negative resection margins vary, and the benefit of routine portal vein resection (PVR) is discussed controversially.

Methods

The data of 60 consecutive patients who underwent LR for HCA were analyzed. Twenty-one patients (35.0%) underwent LR plus PVR and 39 (65.0%) LR only. Clinicopathologic data were evaluated by the use of uni- and multivariate analyses.

Results

The majority of resections was performed for Bismuth–Corlette type III/IV tumors (97.3%). Hepatectomy involved trisectionectomies in 41 patients (68.3%). R1 resection margin status was identified as adverse prognosis factor for survival (hazard ratio 3.61; P = .003). PVR increased the perioperative morbidity (P = .04). The 90-day mortality rate was comparable between both groups (P = .70). Negative resection margin status was similar between groups (P = .70). The lymph node clearance was equal (P = .86). PVR was not associated with a beneficial long-term outcome, the 5-year and disease-free survival were comparable (LR only 17.8% vs LR plus PVR 20.0% [P = .89] and LR only 10.6% vs LR plus PVR 21.4% [P = .63]). PVR was no prognostic factor for tumor-dependent or disease-free survival (hazard ratio 0.64; P = .26 and hazard ratio 0.76; P = .47).

Conclusion

The presented data indicate that simultaneous PVR has no beneficial impact on oncologic long-term outcome in patients undergoing LR for HCA. Because it increases the perioperative morbidity, a recommendation for routine application cannot be given.