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1.
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
2.
Intrahepatic cholangiocarcinoma in Korea 总被引:1,自引:0,他引:1
Hong-Jin Kim Sung-Su Yun Ki-Ho Jung Woo-Hyung Kwun Joon-Hyuk Choi 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(2):142-148
We reviewed surgically treated patients with intrahepatic cholangiocarcinoma to evaluate the clinical and pathologic features
of intrahepatic cholangiocarcinoma that may affect long-term survival in Korean patients with the disease. Between 1990 and
1997, 28 patients with intrahepatic cholangiocarcinoma underwent laparotomy. Resection was performed in 25 patients, and wedge
resection alone in 3 patients. The liver resections consisted of right lobectomy in 5 patients, right trisegmentectomy in
1, left lobectomy in 7, extended left lobectomy in 3, hepatopancreatoduodenectomy in 2, and segmentectomy in 7. Curative resection
was performed in 15 patients. Histological sections of all resected specimens were immunohistochemically stained with p53
and Ki-67 monoclonal antibodies to assess the biological behavior of the tumor cells. Cumulative survival rate and clinicopathological
factors that may influence the prognosis, including biological markers (p53, Ki-67), were analyzed statistically. Patients
who underwent curative resection survived significantly longer than patients who underwent noncurative resection. The median
survival time of the patients who underwent curative resection was 24 months (mean, 34 ± 8 months), with 1-, 2-, and 3-year
survival rates of 66.6%, 44.4%, and 35.6%, respectively. The median survival time of the patients who underwent noncurative
resection was 3 months (mean, 8 ± 3 months), with 1- and 2-year survival rates of 26.7% and 13.4%, respectively. Univariate
analysis showed that positive regional lymph nodes correlated significantly with poor outcome (P = 0.004) and that curative resection significantly correlated with better prognosis (P = 0.001). Age, sex, tumor size, degree of cell differentiation, gross type of tumor, and p53 and Ki-67 labeling index were
not significantly correlated with outcome. Our findings support the concept that aggressive liver resection, along with regional
lymph node dissection, be recommended for long-term survival. The validity of molecular biologic tumor markers (p53, Ki-67)
as prognostic factors has not yet been clearly demonstrated.
Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998 相似文献
3.
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
4.
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
5.
Murakami Y Uemura K Sudo T Hashimoto Y Nakashima A Kondo N Sakabe R Ohge H Sueda T 《Annals of surgical oncology》2011,18(3):651-658
Background
The prognosis of patients with cholangiocarcinoma is unsatisfactory. Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their long-term survival. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma.Materials and Methods
Records of 127 patients with cholangiocarcinoma (21 with intrahepatic cholangiocarcinoma, 50 with hilar cholangiocarcinoma, and 56 with distal cholangiocarcinoma) who underwent surgical resection were reviewed retrospectively. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate analysis.Results
For all 127 patients, overall 1-, 3-, 5-year survival rates were 80, 51, and 40%, respectively. Univariate analysis revealed that adjuvant chemotherapy (P = .049), tumor differentiation (P = .014), lymph node metastasis (P < .001), surgical margin status (P < .001), UICC pT factor (P < .001), and UICC stage (P < .001) were associated significantly with survival. UICC pT factor (P = .007), adjuvant chemotherapy (P = .009), surgical margin status (P = .012), and lymph node metastasis (P = .014) remained independently associated with long-term survival by multivariate analysis. The 5-year survival rates of patients with or without positive surgical margins were 13 and 49%, respectively. The 5-year survival rates of patients treated with or without adjuvant chemotherapy were 47 and 36%, respectively.Conclusions
R0 resection and adjuvant chemotherapy may be mandatory to achieve long-term survival for patients with cholangiocarcinoma. 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.
Purpose Some studies suggest that giving radiation therapy after surgery for hilar cholangiocarcinoma improves the survival rate; however, many of these studies did not specify numbers of subjects or provide an impartial analysis. Thus, we evaluated the effectiveness of radiation therapy as adjuvant treatment after surgery and attempted to establish appropriate adaptation standards.Methods We reviewed the records of 69 patients who underwent surgery for hilar cholangiocarcinoma between June 1980 and April 1998. Thirty-nine patients were treated with surgery followed by radiation therapy and 30 were treated with surgery alone.Results The clinicopathologic features that might have influenced prognosis were similar in the patients who received radiation therapy and those who did not. Radiation as adjuvant therapy did not have a beneficial effect on overall survival (P = 0.554, log-rank test); however, it tended to improve survival in the group of patients who underwent curative resection for with p-stage III or IVa disease (P = 0.042, log-rank test).Conclusions Radiation therapy after surgery did not show any clinical benefits for patients with hilar cholangiocarcinoma. However, it may be effective as adjuvant therapy after curative resection in a small subgroup of patients with p-stage III or IVa disease. 相似文献
8.
Amanda K Arrington Rebecca A Nelson Ann Falor Carrie Luu Rebecca L Wiatrek Marwan Fakih Gagandeep Singh Joseph Kim 《World journal of gastrointestinal surgery》2013,5(6):178-186
AIM:To examine surgical and medical outcomes for patients with cholangiocarcinoma using a populationbased cancer registry.METHODS:Using the California Cancer Registry’s Cancer Surveillance Program,patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received(surgery,radiation,and chemotherapy).The surgical cohort was further categorized into three treatment groups:patients who received adjuvant chemotherapy,adjuvant chemoradiation,or underwent surgery alone(no chemotherapy or radiation administered).Survival was assessed by Kaplan-Meier method;and Cox proportional hazard modeling was used in multivariate analysis.RESULTS:Of 825 patients,60.2% received no treatment.Of the remaining 328 patients,18.5% chemotherapy only,7.4% chemoradiation,and 13.8% underwent surgery.More male patients underwent surgical resection(P = 0.004).Surgical patients were younger than the patients receiving chemotherapy or chemoradiation(P < 0.001).Of the surgical cohort(n = 114),60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy(chemotherapy n = 20;chemoradiation,n = 21)(P < 0.001).Median survival for all patients in the study was 6.6 mo.Median survival was highest for patients who underwent surgery(23 mo),whereas both chemotherapy(9 mo) and chemoradiation(8 mo) alone were each less effective(P < 0.001).By multivariate analysis,extent of disease,receipt of surgery,and administration of chemotherapy(with/without surgery) were independent predictors of overall survival.CONCLUSION:This study demonstrates that surgery is a critical treatment modality.Multimodality treatment has yet to be standardized,but play a role in optimal therapy for cholangiocarcinoma. 相似文献
9.
Aggressive surgical resection for hilar-invasive and peripheral intrahepatic cholangiocarcinoma 总被引:11,自引:1,他引:10
Nakagohri T Asano T Kinoshita H Kenmochi T Urashima T Miura F Ochiai T 《World journal of surgery》2003,27(3):289-293
Abstract
The clinicopathology and surgical outcome of intrahepatic cholangiocarcinomas are not fully understood. The objective of this
study was to clarify the clinicopathologic features of intrahepatic cholangiocarcinoma and evaluate prognostic factors influencing
survival. Forty consecutive patients with intrahepatic cholangiocarcinomas undergoing surgical resection at Chiba University
Hospital between October 1981 and October 1997 were analyzed retrospectively. Intrahepatic cholangiocarcinomas were classified
as hilar-invasive type (n = 26) or peripheral type (n = 14). Patients with peripheral-type tumors had a significantly (p = 0.005) better 5-year survival rate (43%) than those with the hilar-invasive type (4%). Hilar-invasive-type tumors had perineural
invasion (100%) and nodal involvement (85%) more frequently than did peripheral-type tumors. Despite aggressive surgical resection,
the surgical margin was positive in 88% of patients with hilar-invasive type tumors (23/26) and 29% of patients with peripheral-type
tumors (4/14). There was no evidence of a survival benefit of vascular resection for patients with a hilar-invasive intrahepatic
cholangiocarcinoma. Patients with lymph node metastasis had a significantly worse prognosis (p = 0.0004). No patients with nodal involvement survived more than 38 months. Negative perineural invasion (p = 0.008) and a negative microscopic margin (p = 0.008) were significantly associated with improved survival. Better survival results could be achieved by curative resection
with a free margin for hilar-invasive and peripheral intrahepatic cholangiocarcinoma.
Electronic Publication 相似文献
10.
Sae Murakami Tetsuo Ajiki Taro Okazaki Kimihiko Ueno Masahiro Kido Ippei Matsumoto Takumi Fukumoto Yonson Ku 《Surgery today》2014,44(10):1847-1854
Purpose
This study aimed at assessing the prognostic factors of resection of intrahepatic cholangiocarcinoma (IHCC), which remain unclear.Methods
Among 70 patients with IHCC, who were admitted to our hospital between 1998 and 2011, 45 (64 %) underwent resection and 25 had unresectable tumors. Univariate and multivariate analyses were conducted retrospectively to assess the factors influencing survival of the patients who underwent resection.Results
The median survival times of the patients who underwent resection versus those who did not were 16 months versus 9 months, respectively (P < 0.001). Multivariate analysis identified residual tumor status (relative risk 4.12, P = 0.04) and pathological differentiation (relative risk 5.55, P = 0.04) as independent factors predicting survival. Patients who underwent R1 resection had a significantly higher rate of local recurrence than those who underwent R0 resection (P = 0.008). With R0 resection, there were no significant differences in patterns and rates of recurrence between patients with narrow (≤5 mm) versus wide (>5 mm) surgical margins.Conclusions
R0/1 resection and a well-differentiated tumor were found to be independent prognostic factors for long-term survival after IHCC resection. If R0 resection was achieved, the width of the negative surgical margin did not affect the patterns and rates of recurrence. 相似文献11.
Masakazu Yamamoto Ken Takasaki Takehito Otsubo Hideo Katsuragawa Satoshi Katagiri 《Journal of Hepato-Biliary-Pancreatic Surgery》2001,8(2):154-157
We aimed to assess the patterns of recurrence after surgery for intrahepatic cholangiocarcinoma (ICC) and the outcomes of treatment in patients with recurrence. From 1981 to 1999, 123 patients with ICC underwent hepatectomy. The 3-year and 5-year survival rates were significantly higher in patients after curative resection (n = 56; 53%, 50%) than in patients after noncurative resection (n = 67; 7%, 2%; P < 0.0001). In 54 patients followed-up after curative resection, the rate of recurrence after surgery was 46%. The recurrences were in the liver (56%), abdomen (disseminated; 24%), and lymph nodes (20%). The rates of recurrence were significantly higher in patients with various classifications of mass-forming ICC tumors (P = 0.039) than in those with other types of tumors, and in patients with tumors over 3 cm in greatest diameter than in those with tumors 3 cm or less (P = 0.006). Hepatic recurrence, abdominal dissemination, and intraductal recurrence were significantly related to tumors that included mass-forming ICC (P = 0.002), tumors that included periductal infiltrating ICC (P = 0.009), and tumors that included intraductal growth ICC (P = 0.038), respectively. Seven patients with recurrence underwent radiation, chemotherapy, immunotherapy, or surgical resection. Only 2 patients, with intrahepatic metastasis and intraductal recurrence, respectively, had good outcomes after surgery. The effectiveness of other treatments has not been established. 相似文献
12.
Clinicopathological features and outcome of hepatic resection for intrahepatic cholangiocarcinoma in Japan 总被引:4,自引:0,他引:4
Shuji Isaji Yoshifumi Kawarada Hiroki Taoka Masami Tabata Hideo Suzuki Hajime Yokoi 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(2):108-116
As a result of an increasing number of studies on the surgical treatment of intrahepatic cholangiocarcinoma (ICC), knowledge
of its biological characteristics has been accumulating. We analyzed the clinicopathological features and outcome of 36 of
48 surgical patients with histologically proven ICC (75.0%) who underwent hepatic resection between March 1979 and July 1998.
According to tumor location, 12 patients had the central type and 24, the peripheral type. The incidence of portal vein tumor
thrombus and lymph node metastasis was higher in the central type than in the peripheral type. All 12 patients with the central
type had stage IV disease, and none of them underwent complete resection, whereas 12 of the 24 patients with peripheral type
tumors had stage IV disease; complete resection was achieved in 12 of the 24 patients with peripheral type tumors (50%). Outcome
after resection was significantly poorer in the patients with the central type. The macroscopic type of lesion in the resected
specimens was the mass-forming type in 15 patients (41.7%), the mass-forming + periductal-infiltrating type in 15 patients
(41.7%), the periductal-infiltrating type in 3 patients (8.3%) and the intraductal growth type in 3 patients (8.3%). The macroscopic
tumor type was associated with mode of tumor spread and outcome. All 3 patients with the intraductal growth type are alive
without tumor recurrence 26–138 months after surgery. The survival rate was much higher in the patients with the mass-forming
type than in those with the mass-forming + periductal-infiltrating type. Importantly, the outcome in the 17 patients who underwent
resection for stage IV-B disease and who accounted for 47.2% of patients with resection in the present series was very poor,
almost the same as that in the 12 patients who did not undergo resection. By selecting patients based on the biological characteristics
of the tumor and taking into account patients' quality of life, complete surgical resection can be performed safely and is
associated with long-term survival.
Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998 相似文献
13.
Naoko Iwahashi Kondo Ken Shirabe Yohei Mano Akinobu Taketomi Tomoharu Yoshizumi Toru Ikegami Toshiro Masuda Hiroto Kayashima Naotaka Hashimoto Kazutoyo Morita Mizue Matsuo Yoshihiko Maehara 《Surgery today》2012,42(12):1210-1214
The outcome after surgical resection for intrahepatic cholangiocarcinoma has not been satisfactorily evaluated due to its malignant behavior. Surgical resection, however, has the potential to improve the prognosis and may allow surgeons to experience rare cases with long survival. This report presents the case of a patient who developed recurrence 9?years after resection of intrahepatic cholangiocarcinoma. A 76-year-old female was diagnosed to have intrahepatic cholangiocarcinoma and underwent an extended right posterior subsegmentectomy. The gross appearance showed a mass-forming type tumor. The histopathological examination revealed well to moderately differentiated adenocarcinoma associated with portal vein invasion. Subcutaneous metastasis in the head as the first sign of relapse was diagnosed 9?years after hepatectomy. The histopathological findings of the subcutaneous tumor were similar to those of the intrahepatic cholangiocarcinoma, thus suggesting metastasis from intrahepatic cholangiocarcinoma. Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-d-glucose was useful for detecting multiple metastases. Long-term follow-up for more than 5?years is recommended because the present case shows that late recurrence of intrahepatic cholangiocarcinoma occurs even 5?years after resection. 相似文献
14.
Rea DJ Munoz-Juarez M Farnell MB Donohue JH Que FG Crownhart B Larson D Nagorney DM 《Archives of surgery (Chicago, Ill. : 1960)》2004,139(5):514-23; discussion 523-5
HYPOTHESIS: Major hepatectomy, bile duct resection, and regional lymphadenectomy for hilar cholangiocarcinoma are associated with actual long-term (>5 years) survival. DESIGN: Retrospective outcome study. SETTING: Single tertiary referral institution. PATIENTS: Between 1979 and 1997, 46 consecutive patients had resection of hilar cholangiocarcinoma by major hepatectomy, bile duct resection, and regional lymphadenectomy. MAIN OUTCOME MEASURES: Overall survival and tumor recurrence were correlated to clinicopathological factors, operative morbidity, and mortality. RESULTS: Twenty-five patients underwent left hepatectomy, 17 underwent right hepatectomy, and 4 had extended right hepatectomy. Eighteen patients underwent resection of segment 1. Negative (R0) resection margins were achieved in 37 patients (80%). The operative mortality rate was 9%, and the surgical morbidity rate was 52%. Actual 1-year, 3-year, and 5-year survival rates were 80%, 39%, and 26%, respectively. Factors adversely associated with patient survival rates included: male sex, lymph node metastases, tumor grade 3 or 4, elevated direct serum bilirubin level at diagnosis, elevated preoperative activated partial thromboplastin time, and more than 4 U of red blood cells transfused perioperatively. Tumor size and R0 resection approached significance for survival. Factors associated with tumor recurrence included: male sex, tumor grade 3 or 4, a low hemoglobin level both at diagnosis and preoperatively, and a low preoperative prothrombin time and low alkaline phosphatase level at diagnosis and preoperatively. Median time to recurrence was 3.6 years. Tumor recurrence was predominantly local and regional. CONCLUSIONS: The actual 5-year survival rate of 26% justifies major partial hepatectomy, bile duct resection, and regional lymphadenectomy for hilar cholangiocarcinoma. The high frequency of local and regional recurrence warrants investigation of adjuvant therapy. 相似文献
15.
Dinant S Gerhards MF Rauws EA Busch OR Gouma DJ van Gulik TM 《Annals of surgical oncology》2006,13(6):872-880
Background Treatment of hilar cholangiocarcinoma (Klatskin tumors) has changed in many aspects. A more extensive surgical approach, as
proposed by Japanese surgeons, has been applied in our center over the last 5 years; it combines hilar resection with partial
hepatectomy for most tumors. The aim of this study was to assess the outcome of a 15-year evolution in the surgical treatment
of Klatskin tumors.
Methods A total of 99 consecutive patients underwent resection for hilar cholangiocarcinoma in three 5-year time periods: periods
1 (1988–1993; n = 45), 2 (1993–1998; n = 25), and 3 (1998–2003; n = 29). Outcome was evaluated by assessment of completeness
of resection, postoperative morbidity and mortality, and survival.
Results The proportion of margin negative resections increased significantly from 13% in period 1 to 59% in period 3 (P < .05). Two-year survival increased significantly from 33% ± 7% and 39% ± 10% in periods 1 and 2 to 60% ± 11% in period 3
(P < .05). Postoperative morbidity and mortality were considerable but did not increase with this changed surgical strategy
(68% and 10%, respectively, in period 3). Lymph node metastasis was, next to period of resection, also associated with survival
in univariate analysis.
Conclusions Mainly in the last 5-year period (1998–2003), when the Japanese surgical approach was followed, more hilar resections were
combined with partial liver resections that included segments 1 and 4, thus leading to more R0 resections. This, together
with a decrease in lymph node metastases, resulted in improved survival without significantly affecting postoperative morbidity
or mortality. 相似文献
16.
Kazuhiro Otani Kazuo Chijiiwa Masahiro Kai Jiro Ohuchida Motoaki Nagano Kazuyo Tsuchiya Kazuhiro Kondo 《Journal of gastrointestinal surgery》2008,12(6):1033-1040
To evaluate surgical results and the effect of adjuvant chemotherapy in cases of hilar cholangiocarcinoma, we retrospectively
analyzed 27 consecutive patients who underwent surgical resection (eight bile duct resections, 18 bile duct resections plus
hepatectomy, one hepatopancreaticoduodenectomy). There was no operative mortality, and the morbidity was 37%. Curative resection
(R0 resection) was achieved in 20 (74%) patients. Overall survival at 3 and 5 years was 44% and 27%, significantly higher
than that of 47 patients who did not undergo resection (3.5% and 0% at 3 and 5 years, p < 0.0001). Survival of patients with positive margins (R1/2 resection) was poor; there were no 5-year survivors. However,
survival was better than that of patients who did not undergo resection (median survival: 22 vs 9 months, p = 0.0007). Univariate analysis identified lymph node metastasis as a negative prognostic factor (p = 0.043). Median survival of patients who underwent adjuvant chemotherapy was significantly longer than that of patients
who did not (42 vs. 22 months, p = 0.0428). Resection should be considered as the first option for hilar cholangiocarcinoma. There appears to be a survival
advantage even in patients with cancer-positive margins. Adjuvant chemotherapy may increase long-term survival. 相似文献
17.
Background : Despite the widespread use of surgical resection as a treatment for hepatic colorectal metastases, the value of resecting more than three metastases remains controversial. It was the objective of this study to determine if resection of larger numbers of metastases affects patient survival. Method : The survival of 123 consecutive patients who underwent curative hepatic resection for colorectal metastases between 1989 and 1999 by a single surgeon was analysed retrospectively. Kaplan–Meier survival statistics and Cox regression were used to determine the factors that affected survival, and logistic regression was used to determine the factors that affected the risk of recurrence of hepatic disease. Results : The median survival rate for the whole group of patients was 38 months, with 1, 3 and 5 year survival rates of 88%, 53% and 31% respectively. The survival rate of patients undergoing resection of four to seven metastases (n = 22; 5 year survival = 39%) was not significantly different to that of patients undergoing resection of one to three metastases (n = 91; 5 year survival = 30%), P = 0.9. Age, sex, primary cancer site, hepatic disease distribution, resection margins and adjuvant hepatic arterial chemotherapy (HAC) did not affect survival. Local invasion of the hepatic metastases (relative risk (RR) = 2.9; P = 0.001) and hepatic disease recurrence (RR = 2.1; P = 0.007) were the only factors that independently affected survival. Local invasion of the hepatic metastasis was the only factor associated with an increased risk of hepatic recurrence (RR = 2.8; P = 0.03). Adjuvant HAC did not affect the risk of hepatic recurrence (RR = 1.5, P = 0.4). Conclusion : Although there are no randomized trials that quantify any survival benefit from resection of liver metastases, the comparison of our results with well documented historical evidence indicates that surgical resection of up to seven colorectal liver metastases can result in a significant survival benefit. 相似文献
18.
Poon RT Fan ST O'Suilleabhain CB Wong J 《Journal of the American College of Surgeons》2002,195(3):311-318
BACKGROUND: Resection of hepatocellular carcinoma (HCC) is associated with a high incidence of recurrence. Aggressive management of recurrence is an important strategy in prolonging survival. This study evaluated the role of combined resection and locoregional therapy in the management of selected patients with extrahepatic and intrahepatic recurrences. STUDY DESIGN: From a prospective database of 399 patients with hepatectomy for HCC from 1989 to 1998, 63 patients were identified with extrahepatic and intrahepatic recurrences either concurrently or sequentially. Survival outcomes of patients who underwent resection of extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence were evaluated. RESULTS: Ten patients underwent resection of solitary extrahepatic recurrence and locoregional therapy for intrahepatic recurrence. Transarterial chemoembolization was the main treatment modality for intrahepatic recurrence. Two of these patients also underwent re-resection of intrahepatic recurrence at the time of resection of extrahepatic metastasis. Median survival after recurrence of these 10 patients was 44.0 months (range 18.6 to 132.9 months), and the median overall survival from initial hepatectomy was 49.0 months (range 21.6 to 134.6 months). In contrast, median survival after recurrence of the remaining 53 patients with extrahepatic and intrahepatic recurrences treated by nonsurgical means (locoregional therapy, systemic chemotherapy, or hormonal therapy) was only 10.6 months (p = 0.002). CONCLUSIONS: Aggressive management with combined resection of isolated extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence may offer longterm survival in selected patients who develop both intrahepatic and extrahepatic recurrences after hepatectomy for HCC. 相似文献
19.
Intrahepatic cholangiocarcinoma in Taiwan 总被引:4,自引:0,他引:4
Miin-Fu Chen Yi-Yin Jan Long-Bin Jeng Tsann-Long Hwang Chia-Siu Wang Shin-Cheh Chen Tzu-Chieh Chao Han-Ming Chen Wei-Chen Lee Ta-Sen Yeh Yun-Fan Lo 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(2):136-141
We report our experience of the surgical treatment of intrahepatic cholangiocarcinoma (ICC) in Taiwanese patients. A tota1
of 162 patients with histologically proven ICC were treated of whom 106 (65.4%) had associated hepatolithiasis. Patients with
hepatolithiasis were in earlier stages than those without hepatolithiasis. Two-thirds of the patients with hepatolithiasis
presented with acute cholangitis, and two-thirds of those without hepatolithiasis presented with hepatomegaly. The rate of
hepatic resection was 29.6% (48 of 162), and these rates were 31.1% and 26.8% for the patients with and without hepatolithiasis,
respectively. Ninety-three percent of the patients with hepatolithiasis underwent common bile duct exploration, compared with
18% of those without hepatolithiasis. The surgical mortality rates were 3.7% (6/162), for all patients, and 3.8% and 3.6%
for patients with and without hepatolithiasis, respectively. The morbidity rate was much higher in the patients with hepatolithiasis
(37.7% vs 16.1%). The 1-, 3-, and 5-year survival rates were 35.5%, 20.5%, and 16.5% in the patients with hepatolithiasis
and 27.2%, 8.8%, and 7.8% in those without hepatolithiasis. Concomitant hepatolithiasis prevented precise diagnosis preoperatively
and precipitated biliary sepsis, which affected resectability and increased postoperative morbidity. Hepatolithiasis per se
did not influence long-term survival.
Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998 相似文献
20.
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