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1.
Nakagohri T Kinoshita T Konishi M Takahashi S Gotohda N 《World journal of surgery》2008,32(12):2675-2680
BACKGROUND: The clinicopathologic features and surgical outcome of intrahepatic cholangiocarcinoma are not fully understood. METHODS: Fifty-six consecutive patients with intrahepatic cholangiocarcinoma who underwent surgical resection at the National Cancer Center Hospital East between October 1992 and July 2007 were retrospectively analyzed. Intrahepatic cholangiocarcinomas were subdivided into solitary tumors and tumors with intrahepatic metastasis. RESULTS: Complete tumor removal (R0 resection) was performed in 42 patients (75%). The 5-year survival rate for patients with intrahepatic cholangiocarcinoma (n = 56), patients with a solitary tumor (n = 46), and patients with intrahepatic metastasis (n = 10) were 32, 38, and 0%, respectively. There was a significant difference in survival between patients with a solitary tumor and those with intrahepatic metastasis (p < 0.0001). The 5-year survival rate for patients with stage I (n = 3), II (n = 9), III (n = 15), and IV disease (n = 26) was 100, 67, 37, and 0%, respectively. There was a significant difference in survival between stage I and stage IV (p = 0.011), between stage II and stage IV (p = 0.0002), and between stage III and stage IV (p = 0.0015). The most frequent site of recurrence was the liver. Univariate analysis showed that intrahepatic metastasis, portal vein invasion, hepatic duct invasion, lymph node metastasis, perineural invasion, and positive surgical margin (R1) were significantly associated with poor survival. Multivariate analysis confirmed that intrahepatic metastasis was a significant and independent prognostic indicator after surgical resection for intrahepatic cholangiocarcinoma (p = 0.001). No patient with intrahepatic metastasis survived more than 10 months in this study. CONCLUSIONS: Intrahepatic metastasis was the strongest predictor of poor survival in intrahepatic cholangiocarcinoma. 相似文献
2.
Woo SM Ryu JK Lee SH Yoo JW Park JK Kim YT Jang JY Kim SW Kang GH Yoon YB 《Annals of surgical oncology》2007,14(11):3195-3201
Background Ampullary carcinoma is often considered to have a better prognosis than distal extrahepatic cholangiocarcinoma. However, studies
that directly compare the recurrence and histopathological features between the two groups are rare.
Methods Clinicopathologic factors and the long-term outcomes of 163 patients with ampullary carcinoma after radical resection were
retrospectively evaluated and compared with those of 91 patients with distal extrahepatic cholangiocarcinoma.
Results Among the 163 ampullary carcinomas, T1 stage, well-differentiated tumors and perineural invasion were 45 (28%), 73 (45%),
and 23 (14%), respectively, whereas, only five (6%) were T1 stage, 15 (17%) were well differentiated, and 63 (69%) showed
perineural invasion (p < 0.001, for all) in distal extrahepatic cholangiocarcinomas. More patients with distal extrahepatic cholangiocarcinoma had
liver metastasis than ampullary carcinoma (24% vs. 10%, p = 0.004). Multivariate analysis identified venous invasion and perineural invasion as risk factors for recurrence of ampullary
carcinoma after radical resection. Only lymph node involvement was identified as a risk factor for recurrence of distal extrahepatic
cholangiocarcinoma by multivariate analysis. Overall five-year survival of patients with ampullary cancer was higher than
that of patients with distal extrahepatic cholangiocarcinoma (68% vs. 54%; p = 0.033). In patients without lymph node metastasis, a significant difference in survival was also observed between the two
groups (p = 0.049).
Conclusion Earlier diagnosis and the less frequent occurrence of pathological factors associated with tumor invasiveness in ampullary
carcinoma than in distal extrahepatic cholangiocarcinoma may explain its association with a better prognosis. 相似文献
3.
Clinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma. 总被引:8,自引:0,他引:8
T Uenishi K Hirohashi S Kubo T Yamamoto O Yamazaki H Kinoshita 《The British journal of surgery》2001,88(7):969-974
BACKGROUND: The prognosis for patients with intrahepatic cholangiocarcinoma differs according to macroscopic type. The identification of clinical and pathological features that predict outcome in patients with mass-forming intrahepatic cholangiocarcinoma is required in order to determine optimal surgical strategies for patients with this type of tumour. METHODS: The details of 35 patients with resected mass-forming intrahepatic cholangiocarcinomas were analysed retrospectively. Univariate analysis of potential prognostic factors was performed. RESULTS: The cumulative survival rate at 1, 3 and 5 years after operation was 58, 33 and 33 per cent respectively. Patients with stage II tumours had a better outcome than those with advanced stage tumours. By univariate analysis, lymphatic invasion, lymph node metastasis, intrahepatic satellite lesions and microscopic resection margin involvement were found to be highly significant variables and were identified as possible risk factors for a poor outcome after operation. CONCLUSION: When frozen-section examination of lymph nodes reveals negative nodal metastasis, extensive anatomical hepatic resection is indicated for mass-forming intrahepatic cholangiocarcinomas. Intraoperative frozen-section examination of the resection margin to confirm the absence of cancer cells is recommended. 相似文献
4.
Hirohashi K Uenishi T Kubo S Yamamoto T Tanaka H Shuto T Yamasaki O Horii K Kinoshita H 《Journal of Hepato-Biliary-Pancreatic Surgery》2002,9(2):233-236
Abstract.
Background/Purpose: Although curative surgical resection provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma,
the presence of bile duct invasion decreases postoperative survival rates in patients with mass-forming intrahepatic cholangiocarcinoma.
We carried out this study to determine a surgical strategy for patients with bile duct invasion of these tumors.
Methods: Forty-one patients with mass-forming intrahepatic cholangiocarcinoma were classified as either having bile duct invasion
(n= 26) or not having bile duct invasion (n= 15). Clinicopathologic findings, including postoperative outcomes, were compared between these two groups.
Results: Perineural invasion, lymphatic invasion, and a positive resection margin were more frequent in patients with ductal invasion.
Patients with ductal invasion had lower survival rates than those without ductal invasion.
Conclusions: Intraoperative frozen section examination of the bile duct stump to confirm a clear resection margin is required in patients
with mass-forming tumors. Resection of the extrahepatic bile duct should be considered when tumor cells are identified at
the surgical margin of the resected bile duct.
Received: October 30, 2001 / accepted: November 16, 2001 相似文献
5.
Resection of intrahepatic cholangiocarcinoma: a Western experience 总被引:10,自引:0,他引:10
Alain Valverde Nicolas Bonhomme Olivier Farges Alain Sauvanet Jean F. Flejou Jacques Belghiti 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(2):122-127
We analyzed the results of an aggressive surgical approach to intrahepatic cholangiocarcinoma. Between 1990 and 1997, 30
of 42 patients with intrahepatic cholangiocarcinoma underwent resection with curative intent. Mean tumor size was 10 ± 5 cm,
and the tumors were classified as TNM type III, IVa, and IVb in 63%, 34%, and 3% of the patients, respectively. All patients
underwent hepaticoduodenal lymphadenectomy. Fifteen patients received adjuvant radio- and chemotherapy. The overall survival
rates at 1, 2, and 3 years were 86%, 63%, and 22%, respectively, and the median survival time was 28 months. Tumor recurrence
was the main cause of death. Three patients survived for more than 5 years, including 2 patients with no evidence of recurrence.
Factors influencing survival were: presence of satellite nodules (P = 0.007) and lymph node invasion (P = 0.05). The width of the resection margin and the use of an adjuvant therapy had no impact on survival. Complete surgical
resection may offer a chance for long-term survival in selected patients and may improve the quality of life of patients with
more advanced disease.
Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998 相似文献
6.
Ohtsuka M Ito H Kimura F Shimizu H Togawa A Yoshidome H Shimamura F Shimizu Y Miyazaki M 《Journal of Hepato-Biliary-Pancreatic Surgery》2003,10(4):259-264
Background/Purpose. The aim of this report was to assess the outcome of aggressive surgical treatment for intrahepatic cholangiocarcinoma.
Methods. From 1984 to 2001, we encountered 64 patients with intrahepatic cholangiocarcinoma. Of the 64 patients, 50 patients who underwent surgical resection with macroscopically curative objectives (78%) were reviewed for surgical procedures and outcomes.
Results. Hemi- or more extensive hepatectomy was required for surgical resection in 40 patients (80%). Overall hospital morbidity and mortality rates were 50% and 8%, respectively. Curative resection with pathological free margins was achieved in 34 patients (68%). The 1-, 3-, and 5-year patient survival and tumor-free survival rates were 61.6%, 37.6%, and 22.5%; and 55%, 11%, and 11%, respectively. Among the macroscopic types, all 9 patients with intraductal growth type are alive 11–75 months after surgery. Survival rates among patients who had undergone curative resection were significantly better than those in patients who had undergone noncurative resection, even when patients with the intraductal growth type were excluded. Nodal status did not affect patient survival.
Conclusions. Although the overall survival rate after surgical resection remains unsatisfactory, long-term survival is possible through extended surgical resection with pathological free margins. Patients with the intraductal growth type of intrahepatic cholangiocarcinoma might have the best chance of being cured by surgical treatment. 相似文献
7.
Uenishi T Yamazaki O Tanaka H Takemura S Yamamoto T Tanaka S Nishiguchi S Kubo S 《Annals of surgical oncology》2008,15(2):583-589
Background A high serum cytokeratin 19 fragment (CYFRA21-1) concentration in patients with various cancers is associated with poor prognosis.
This study aimed to establish the clinical significance of preoperative serum CYFRA21-1 in patients with intrahepatic cholangiocarcinoma.
Methods CYFRA21-1, carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19-9 concentrations were measured in sera from 71
patients with intrahepatic cholangiocarcinoma. The prognostic significance of serum CYFRA21-1 levels was assessed by univariate
and multivariate analyses.
Results Analysis of the areas under the receiver operator characteristic (ROC) curves clearly showed better discrimination between
intrahepatic cholangiocarcinoma and benign liver diseases for CYFRA 21-1 than for CEA or CA 19-9. Based on the maximization
of the Youden’s index, the optimal cut-off value was 2.7 ng ml−1 for CYFRA 21-1 (sensitivity, 74.7%; specificity, 92.2%). The serum CYFRA21-1 concentration was related to tumor stage, since
the CYFRA21-1 concentrations varied according to tumor size, vascular invasion, and number of tumors. The 3-year recurrence-free
survival rates for patients with high and low concentrations of CYFRA21-1 were 25.0% and 76.2%, respectively (log-rank test,
p < 0.01). The 3-year overall survival rates for patients with high and low concentrations of CYFRA21-1 were 39.4% and 63.6%,
respectively (p = 0.01). On multivariate analysis, a high concentration of CYFRA21-1, nodal metastases, and a microscopic resection margin
involvement were independent prognostic factors associated with both tumor recurrence and postoperative death.
Conclusions A high serum CYFRA21-1 concentration is associated with tumor progression and poor postoperative outcomes in patients with
intrahepatic cholangiocarcinoma. 相似文献
8.
Hernandez J Cowgill SM Al-Saadi S Villadolid D Ross S Kraemer E Shapiro M Mullinax J Cooper J Goldin S Zervos E Rosemurgy A 《Annals of surgical oncology》2008,15(3):807-814
Background With cholangiocarcinoma, the only hope of a cure is resection. This study was undertaken to determine the impact of margin
status, stage, tumor location, and adjuvant therapy on survival after resection of extrahepatic cholangiocarcinoma.
Methods From 1985–2006, 91 patients underwent resections of cholangiocarcinomas. Margin status was codified as micro-/macroscopically
negative, microscopically positive/ macroscopically negative, or micro-/macroscopically positive. Stage was determined using
the AJCC classification (6th edition). Tumor location was classified as proximal, mid, or distal. Proximal tumors were resected by extrahepatic biliary
resection with/without concomitant hepatic resection (n = 48), distal extrahepatic cholangiocarcinomas by pancreaticoduodenectomy (n = 35), and mid tumors by extrahepatic biliary resection alone (n = 8). Regression analysis and survival curve analysis were utilized. Data are presented as median, mean ± standard deviation
(SD).
Results Overall survival after resection was 21 months, 38 ± 46.0. Survival was not impacted by margin status (R0 20 months, 35 ± 45.1
versus R1 32 months, 45 ± 49.4). AJCC stage inversely correlated with survival (p = 0.004, Spearman regression analysis). Tumor location did not impact upon survival (p = 0.57, log-rank test). For proximal tumors, survival after biliary resection was significantly impacted by the need for concomitant
hepatectomy (15 months, 27 ± 31.4 versus 41 months, 67 ± 17.1). Utilization of adjuvant therapy significantly improved survival
(33 months, 56 ± 63.1 versus 19 months, 33 ± 40.0) (p = 0.046, Spearman regression).
Conclusions Survival after resection of extrahepatic cholangiocarcinoma is significantly impacted by AJCC stage, the use of adjuvant therapy,
and in patients with proximal tumors, the need for concomitant hepatectomy. Margin status and tumor location do not impact
survival. Cholangiocarcinomas should be aggressively resected irrespective of tumor location, even if resection might result
in microscopically positive margins, and adjuvant therapy applied. 相似文献
9.
Yoshiaki Murakami Kenichiro Uemura Takeshi Sudo Yasushi Hashimoto Naru Kondo Naoya Nakagawa Takeshi Muto Hayato Sasaki Kazuhide Urabe Taijiro Sueda 《Journal of gastrointestinal surgery》2013,17(8):1429-1439
Background
The significance of perineural invasion in extrahepatic cholangiocarcinoma has not been fully elucidated. This study aims to determine the prognostic impact of and optimal treatment strategy for perineural invasion in patients with extrahepatic cholangiocarcinoma.Methods
Medical records of 133 patients with extrahepatic cholangiocarcinoma who underwent curative resection were reviewed retrospectively. Ninety-eight patients had perineural invasion and 35 patients did not. Univariate and multivariate survival analyses were performed to clarify the prognostic impact of and optimal treatment strategy for perineural invasion.Results
Only tumor differentiation (P?=?0.024) was independently associated with perineural invasion in the multivariate logistic regression model. Multivariate survival analysis revealed that perineural invasion (P?=?0.002), resection margin status (P?=?0.016), and International Union Against Cancer (UICC) pT factor (P?=?0.015) were independent prognostic factors of overall survival. Overall 5-year survival rates for patients with and without perineural invasion were 28 and 74 %, respectively. Among 98 patients with perineural invasion, the use of adjuvant chemotherapy (P?=?0.003), lymph node status (P?=?0.015), resection margin status (P?=?0.008), and UICC pT factor (P?=?0.016) were independently associated with overall survival by multivariate analysis. Overall 5-year survival rates for patients with perineural invasion who did and did not receive adjuvant chemotherapy were 33 and 21 %, respectively (P?=?0.023).Conclusions
Perineural invasion is a potent prognostic factor in extrahepatic cholangiocarcinoma. Adjuvant chemotherapy may improve the overall survival of patients with perineural invasion. 相似文献10.
Namieno T Koito K Takahashi M Une Y Yamashita K Shimamura T 《World journal of surgery》2001,25(5):572-577
We investigated survival-associated histologic and metastatic spreading modes of intrahepatic, peripheral-type cholangiocarcinomas resected to contribute to surgical control of the tumor. Previous results have been mostly obtained from autopsies, reflecting the terminal status of patients. We clinicopathologically reviewed the resected 20 intrahepatic, peripheral-type cholangiocarcinomas and investigated the histologic findings of resected specimens and medical records to assess spreading modes along with patients' survival. The carcinoma cells superficially spread in the ductal epithelium in 75%, infiltrated along Glisson's system and migrated multidirectionally in 100%, and permeated the vascular network in 80%. The cumulative survival rate significantly related to vascular permeation, extrahepatic metastases, and lymphatic, neural, and nodal involvement but not to ductal spread, tumor size (cutoff size 5 cm), or intrahepatic metastases by the log-rank test. The patients with lymphatic, neural, or nodal involvement died early after surgery. Practically, only vascular permeation was identified as a significant independent variable for survival using multivariate analysis. Peripheral cholangiocarcinomas spread mainly in three modes: ductal spread, infiltration along Glisson's system, and vascular permeation. In the practically operable cases, vascular permeation is closely related to survival, and intrahepatic metastasis may be surgically controlled to some degree. 相似文献
11.
Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy 总被引:5,自引:0,他引:5
Serafini FM Sachs D Bloomston M Carey LC Karl RC Murr MM Rosemurgy AS 《The American surgeon》2001,67(9):839-43; discussion 843-4
The role of adjuvant chemoradiation therapy (CT/XRT) in the treatment of cholangiocarcinoma is controversial. We undertook this study to determine whether CT/XRT is appropriate after resection of cholangiocarcinomas. One hundred ninety-two patients with cholangiocarcinomas were treated from 1988 to 1999. After resection, patients were assigned a stage (TNM) and were stratified by location of the tumor as intrahepatic, perihilar, and distal tumors. Data are presented as mean +/- standard deviation. Of 192 patients 92 (48%) underwent resections of cholangiocarcinomas. Thirty-four patients had liver resections, 25 had bile duct resections, and 33 underwent pancreaticoduodenectomies. Thirty-four patients had adjuvant CT/XRT, three had adjuvant chemotherapy, four had neoadjuvant CT/XRT, and 50 had no radiation or chemotherapy. Mean survival of resected patients with adjuvant CT/XRT was 42 +/- 37.0 months and without CT/XRT it was 29 24.5 months (P = 0.07). Mean survival of patients with distal tumors receiving or not receiving CT/XRT was 41 +/- 21.8 versus 25 +/- 20.1 months, respectively, (P = 0.04). Adjuvant chemoradiation improves survival after resection for cholangiocarcinoma (P = 0.07) particularly in patients undergoing resection for distal tumors (P = 0.04). Benefits of adjuvant CT/XRT are apparent when stratified by location of cholangiocarcinomas rather than staging. 相似文献
12.
Shimada K Sano T Sakamoto Y Esaki M Kosuge T Ojima H 《World journal of surgery》2007,31(10):2016-2022
Background The purpose of this study was to clarify the clinicopathologic characteristics and surgical outcomes of patients with the
mass-forming (MF) plus periductal infiltrating (PI) type of intrahepatic cholangiocellular carcinoma (ICC).
Methods Between January 1, 1998, and December 31, 2004, a total of 94 patients with ICC underwent macroscopic curative resection,
and the macroscopic type of the tumors was assessed prospectively. Among the 74 patients with the MF type (n = 46) and the MF plus PI type (n = 28) of ICC, multivariate analysis was conducted to identify the potential prognostic factors. The clinicopathologic data
of the two groups were compared.
Results The results revealed two independent prognostic factors: presence/absence of intrahepatic metastasis and the macroscopic type
of the tumor. ICCs categorized macroscopically as the MF plus PI type were significantly associated with jaundice (p < 0.001), bile duct invasion (p < 0.001), portal vein invasion (p = 0.025), lymph node involvement (p = 0.017), and positive surgical margin (p = 0.038).
Conclusion Identification of the macroscopic type of the tumor is useful for predicting survival after hepatectomy in patients with ICC.
The MF plus PI type of ICC appears to have a more unfavorable prognosis, even after radical surgery, than the MF type of ICC. 相似文献
13.
Extended resection for intrahepatic cholangiocarcinoma in Japan 总被引:4,自引:0,他引:4
Masakazu Yamamoto Ken Takasaki Tatsuya Yoshikawa 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(2):117-121
To elucidate surgical outcome after extended sugery for intrahepatic cholangiocarcinoma (ICC), we retrospectively allocated
83 patients who had undergone resection to a standard surgery group (n = 56), in which the patients had undergone hepatectomy alone or hepatectomy with bile duct resection, and an extended surgery
group (n = 27), in which the patients had undergone the standard operation combined with vessel resection and/or pancreatectomy. The
incidence of mass-forming plus periductal-infiltrating type lesions (P = 0.0129), lymph node metastasis (P = 0.0005), noncurative resection (P < 0.0001), mortality within 30 days and within 1 year after surgery (P = 0.0392, P = 0.0010), local recurrence (P = 0.0439), and peritoneal disseminated recurrence (P = 0.0241) was significantly higher in the extended surgery group than in the standard surgery group. The 5-year survival
rate was significantly higher in the standard surgery group (30%) than in the extended surgery group (10%; P = 0.0061). The mortality rate within 1 year after extended surgery was significantly higher in the patients with infiltrating-spread
type tumors than in the patients with non-infiltrating spread type tumors (P = 0.0032), and long-term (5-year) survival in the extended surgery group was significantly lower in the patients with infiltrating-spread
type tumors than in the patients with non-infiltrating spread type tumors (P = 0.0253). We conclude that extended surgery does not improve the curative resection rate or the surgical outcome of ICC,
and that extended surgery is not indicated for patients with infiltrating-spread type tumors.
Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998 相似文献
14.
Extrahepatic bile duct resection in combination with liver resection for hilar cholangiocarcinoma: A report of 42 cases 总被引:3,自引:0,他引:3
Alexander?J.C.?Ijitsma Bart?M.G.?Appeltans Koert?P.?de?Jong Robert?J.?Porte Paul?M.J.G.?Peeters Maarten?J.H.?Slooff
From September 1986 until December 2001, 42 patients (20 males and 22 females) underwent a combined extrahepatic bile duct
resection (EHBDR) and liver resection (LR) for hilar cholangiocarcinoma (HC). The aim of this study was to analyze patient
survival, morbidity, and mortality as well as to seek predictive factors. The 1-, 3-, and 5-year actuarial patient survival
was 72%, 37%, and 22%, respectively. Median survival was 19 months. Hospital mortality, all due to septic complications, was
12%. Morbidity was observed in 32 patients (76%). Infections were the most dominant complication. Patients (n = 11) with American
Joint Committee on Cancer (AJCC) stage I or stage II tumors exhibited a superior survival compared with patients (n = 31)
with stage III or IV tumors (p = 0.023). Patients with tumor-free lymph nodes (n = 26) indicated a greater survival compared with patients with tumor-positive
lymph nodes (n = 16) (p = 0.004). Patients undergoing vascular reconstructions indicated a trend toward higher mortality and lower survival (p = 0.068). Over 20% of the patients with hilar cholangiocarcinoma can survive more than 5 years after a combined EHBDR and
LR at the cost of 12% perioperative mortality and a 76% morbidity. Results might improve with the prevention of infectious
complications and improved selection of patients to avoid vascular reconstruction and to predict a negative nodal state. 相似文献
15.
Treatment Strategy for Mucin-producing Intrahepatic Cholangiocarcinoma: Value of Percutaneous Transhepatic Biliary Drainage and Cholangioscopy 总被引:3,自引:0,他引:3
Eiji Sakamoto Naokazu Hayakawa Junichi Kamiya Satoshi Kondo Masato Nagino Michio Kanai Masahiko Miyachi Katuhiko Uesaka Yuji Nimura 《World journal of surgery》1999,23(10):1038-1044
Intrahepatic cholangiocarcinomas that secrete macroscopically excessive mucin into the biliary system are rare, and few of
the previously reported cases have achieved a curative resection. We defined these tumors as “mucin-producing intrahepatic
cholangiocarcinomas” and clarify the optimal preoperative and surgical management for them. Eleven patients with mucin-producing
intrahepatic cholangiocarcinomas underwent surgical resection in our department. The clinical, radiologic, surgical, and pathologic
findings were studied. The clinical presentation of the 11 patients included repeated abdominal pain, jaundice, and fever.
Conventional cholangiographies, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography,
could not offer precise information about tumor location and extension because of abundant mucin in the biliary system. Using
percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic cholangioscopy (PTCS), we were able to drain
the mucin and determine precisely the cancer extension into intrahepatic segmental bile ducts. Based on these findings, various
types of liver resection with or without extrahepatic bile duct resection were planned, and 10 patients obtained curative
resection. The cumulative 5-year survival rate after curative resection was 78%. In patients with mucin-producing intrahepatic
cholangiocarcinoma, PTBD and PTCS are important for evaluating the cancer extension. Rational surgery based on accurate preoperative
diagnosis improved the prognosis of patients with this disease. 相似文献
16.
Intrahepatic cholangiocarcinoma in Hong Kong 总被引:3,自引:0,他引:3
We retrospectively analyzed the results of hepatic resection for patients with intrahepatic cholangiocarcinoma managed between
December 1966 and January 1998 at the University of Hong Kong Medical Center, Queen Mary Hospital. There were 61 men and 40
women (mean age, 61.8 years). The clinical records of these patients were reviewed. A survival analysis was performed on the
group of patients who had undergone hepatic resection. Twenty-one patients were treated conservatively. Non-resective (palliative)
operations were performed in 32 patients. The median survivals after conservative management and palliative operation were
2.5 and 3.3 months, respectively. The remaining 48 patients underwent hepatic resection. The overall operative morbidity and
mortality rates after hepatic resection were 41.7% and 16.7%, respectively. The median survival after hepatic resection was
16.4 months. The overall 1-, 3-, and 5-year survival rates after hepatic resection were 60.3%, 29.4% and 22.0%, respectively.
Lymphatic permeation (P = 0.007) and hilar nodal metastases (P = 0.009) were found to be significantly associated with poor survival after hepatic resection. Hepatic resection is the treatment
of choice for intrahepatic cholangiocarcinoma when it is resectable.
Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998 相似文献
17.
Xu-Feng Zhang Fabio Bagante Qinyu Chen Eliza W. Beal Yi Lv Matthew Weiss Irinel Popescu Hugo P. Marques Luca Aldrighetti Shishir K. Maithel Carlo Pulitano Todd W. Bauer Feng Shen George A. Poultsides Olivier Soubrane Guillaume Martel B. Groot Koerkamp Alfredo Guglielmi Timothy M. Pawlik 《Surgery》2018,163(5):1114-1120
Background
Intrahepatic cholangiocarcinoma with hepatic hilus involvement has been either classified as intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma. The present study aimed to investigate the clinicopathologic characteristics and short- and long-term outcomes after curative resection for hilar type intrahepatic cholangiocarcinoma in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma.Methods
A total of 912 patients with mass-forming peripheral intrahepatic cholangiocarcinoma, 101 patients with hilar type intrahepatic cholangiocarcinoma, and 159 patients with hilar cholangiocarcinoma undergoing curative resection from 2000 to 2015 were included from two multi-institutional databases. Clinicopathologic characteristics and short- and long-term outcomes were compared among the 3 groups.Results
Patients with hilar type intrahepatic cholangiocarcinoma had more aggressive tumor characteristics (eg, higher frequency of vascular invasion and lymph nodes metastasis) and experienced more extensive resections in comparison with either peripheral intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma patients. The odds of lymphadenectomy and R0 resection rate among patients with hilar type intrahepatic cholangiocarcinoma were comparable with hilar cholangiocarcinoma patients, but higher than peripheral intrahepatic cholangiocarcinoma patients (lymphadenectomy incidence, 85.1% vs 42.5%, P?<?.001; R0 rate, 75.2% vs 88.8%, P?<?.001). After curative surgery, patients with hilar type intrahepatic cholangiocarcinoma experienced a higher rate of technical-related complications compared with peripheral intrahepatic cholangiocarcinoma patients. Of note, hilar type intrahepatic cholangiocarcinoma was associated with worse disease-specific survival and recurrence-free survival after curative resection versus peripheral intrahepatic cholangiocarcinoma (median disease-specific survival, 26.0 vs 54.0 months, P?<?.001; median recurrence-free survival, 13.0 vs 18.0 months, P?=?.021) and hilar cholangiocarcinoma (median disease-specific survival, 26.0 vs 49.0 months, P?=?.003; median recurrence-free survival, 13.0 vs 33.4 months, P?<?.001).Conclusion
Mass-forming intrahepatic cholangiocarcinoma with hepatic hilus involvement is a more aggressive type of cholangiocarcinoma, which showed distinct clinicopathologic characteristics, worse long-term outcomes after curative resection, in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma. 相似文献18.
Sandra C. Tomaszek YeonSoo Kim Stephen D. Cassivi Matthew R. Jensen Keh-Hsien R. Shen Francis C. Nichols Claude Deschamps Dennis A. Wigle 《European journal of cardio-thoracic surgery》2011,40(5):1151-1156
Objective: Complete surgical resection with pathologic negative margin is associated with the best prognosis in early-stage non-small-cell lung cancer (NSCLC). However, the impact of the length of the bronchial margin remains unknown. This study aimed to determine whether an increased bronchial resection margin length is correlated with an improved disease-free and overall survival rate. Methods: A total of 3936 consecutive pulmonary resections were performed between 25 June 1992 and 31 December 2007 at Mayo Clinic Rochester. A subset consisting of 496 patients with completely resected lesions (R0-resection), and a documented bronchial margin length was analyzed retrospectively. Results: There were 340 men (68.5%) and 156 women (31.5%), with a mean age of 65.9 ± 10.6 years. All patients underwent anatomic lobectomy or larger resection. Final pathology confirmed complete resection without microscopic residual tumor (R0-resection) in all patients. Mean length of the bronchial resection margin was 23.3 ± 15.9 mm. Overall, 190 patients (38.3%) suffered from disease recurrence with local recurrence in 35 patients, distant recurrence in 101, and both local and distant recurrence in 54 patients. Overall 5-year and 10-year local recurrence-free survival was 72.5% (95% confidence interval (CI): 67.3–78.1) and 68.0% (95% CI: 62.1–74.4), distant recurrence free survival 61.0% (95% CI: 55.8–66.6) and 52.9% (95% CI: 46.7–60.1) and overall survival 50.0% (95% CI: 45.1–55.3) and 28.8% (95% CI: 23.8–34.7). Tumor size and N-stage were associated with a worse prognosis in terms of local and distant recurrence, as well as survival (p < 0.05). Histology was not significantly associated with local recurrence (p = 0.28), though adenocarcinoma relative to squamous cell carcinoma was associated with an increased risk of distant recurrence (p < 0.01). There was no significant association between type of surgical resection and local (p = 0.37) or distant recurrence (p = 0.37). Neither local (p = 0.56) or distant recurrence (p = 0.46), nor survival (p = 0.54) was associated with the bronchial margin length. In multivariate models including age, N-stage, and gender there were no significant overall associations of margin length (≤5, 6–10, 11–15, 16–20, >20 mm) and local recurrence (p = 0.51), distant recurrence (p = 0.33), or survival (p = 0.75). Conclusions: When complete surgical resection is achieved, the extent of the bronchial margin has no clinically relevant impact on disease-free and overall survival in NSCLC. 相似文献
19.
Takahiro Uenishi Shoji Kubo Osamu Yamazaki Terumasa Yamada Yo Sasaki Hiroaki Nagano Morito Monden 《Journal of Hepato-Biliary-Pancreatic Surgery》2008,15(4):417-422
BACKGROUND/PURPOSE: The postoperative outcome of patients who have intrahepatic cholangiocarcinoma with lymph node metastases is extremely poor, and the indications for surgery for such patients have yet to be clearly established. METHODS: The demographic and clinical characteristics of 133 patients who underwent lymph node dissection during hepatic resection of intrahepatic cholangiocarcinoma were retrospectively analyzed. RESULTS: Multivariate analysis identified three independent prognostic factors: intrahepatic metastasis, nodal involvement, and tumor at the margin of resection. Of the patients with tumor-free surgical margins, none of the 24 patients who had both lymph node metastases and intrahepatic metastases survived for 3 years. In contrast, the survival rates for the 23 patients who had lymph node metastases associated with a solitary tumor were 35% at 3 years and 26% at 5 years. CONCLUSIONS: Surgery alone cannot prolong survival when both lymph node metastases and intrahepatic metastases are present, while surgery may provide a chance for long-term survival in some patients who have lymph node metastases associated with a solitary intrahepatic cholangiocarcinoma tumor. 相似文献
20.
Kwang Yeol Paik Dong Wook Choi Jun Chul Chung Kyung Tae Kang Sang Bum Kim 《Journal of gastrointestinal surgery》2008,12(7):1268-1274
Background We conducted this study to assess the safety of performing right trisectionectomy with caudate lobectomy for hilar cholangiocarcinoma
by analyzing postoperative mortality and morbidity, and to evaluate the effect of such procedure on pathological curability
and long-term overall survival.
Methods A retrospective clinicopathological analysis was performed for 16 hilar cholangiocarcinoma patients who underwent right trisectionectomy
with caudate lobectomy from June 1999 to April 2003. The median follow-up period was 36.9 months. The preoperative Bismuth–Corlette
type was type II in four patients, type IIIA in 10 patients, and type IV in two patients.
Results The median liver volume after hepatic resection was 21.9% of the total liver volume. Postoperative complications including
one chronic liver failure developed in 12 patients, but no in-hospital deaths occurred. A postoperative pathological examination
showed a cancer free margin in all of the proximal resection sites, although three cases had carcinoma in situ (CIS) lesions in the distal margin that were confirmed during surgery. The 1-, 3-, and 5-year overall survival rates were
94.1%, 64.2%, and 64.2%, respectively.
Conclusion We obtained excellent survival rates without any in-hospital deaths following right trisectionectomy with caudate lobectomy.
This procedure may be an effective surgical procedure that can be executed to achieve low mortality rate and high pathological
curability for hilar cholangiocarcinomas, except for Bismuth type IIIB. 相似文献