T1b/T2期胆囊癌根治性手术中肝切除术时机与临床疗效及预后的关系

背景与目的：胆囊癌（GBC）是最常见的胆道系统恶性肿瘤，根据AJCC TNM分期系统（第8版） T1b/T2期GBC患者需要接受包括胆囊切除术、肝切除和区域淋巴结清扫在内的GBC根治性手术进行治疗。手术时机选择包括胆囊切除联合肝切除和术后病理提示GBC而行二期肝切除手术。目前，GBC根治性手术中关于肝脏切除时机的研究较少。因此，本研究探讨GBC根治性手术中肝脏切除时机选择对患者围术期指标和远期预后的影响。方法：回顾性收集浙江大学医学院附属邵逸夫医院2011年1月—2018年8月行GBC根治性手术的114例T1b/T2期GBC患者资料，其中82例行胆囊切除术同时联合肝切除（一期组），32例行胆囊切除术后再行二期肝切除手术（二期组）。采用倾向性评分匹配（PSM）平衡两组患者基线资料后，比较两组患者的总生存期（OS）和无病生存期（DFS）的差异，分析影响患者OS和DFS的危险因素，并比较两组患者手术时间与住院时间的差异，此外，进一步单独比较二期组中不同手术时间间隔（间隔≤20 d与>20 d）患者围术期指标与预后的差异。结果：按1∶1 PSM后，两组各28例，除GBC诊断时间差异有统计...

Relations of timing of hepatectomy with clinical efficacy and prognosis in radical surgery for T1b/T2 stage gallbladder cancer

Background and aims Gallbladder cancer (GBC) is the most common malignancy of the biliary system. According to the AJCC TNM staging system (8th edition), T1b/T2 stage GBC patients require radical surgery, including cholecystectomy, hepatectomy, and regional lymph node dissection. Timing options for surgery include cholecystectomy combined with hepatectomy and secondary hepatectomy based on postoperative pathological diagnosis of GBC. Currently, there is limited research on the timing of hepatectomy in radical surgery for GBC. Therefore, this study was perfromed to investigate the impact of timing selection for hepatectomy during radical surgery for GBC on perioperative variables and long-term prognosis of patients.Methods The data of 114 patients with T1b/T2 stage GBC who underwent radical surgery in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 2011 to August 2018, were retrospectively collected. Among them, 82 patients underwent cholecystectomy combined with hepatectomy (one-stage group), and 32 patients underwent secondary hepatectomy after cholecystectomy (two-stage group). After balancing the baseline data of the two groups using propensity score matching (PSM), differences in overall survival (OS) and disease-free survival (DFS) were compared, factors influencing OS and DFS of patients were analyzed, and differences in operative time and length of hospital stay between the two groups were also compared. Additionally, within the two-stage group, differences in perioperative indicators and prognosis were compared between patients with different time intervals for surgery (≤20 d vs. >20 d).Results After 1:1 PSM, there were 28 cases in each group, with statistically significant difference only in the time of GBC diagnosis (P<0.05), while other baseline data were balanced and comparable (all P>0.05). Survival analysis showed no statistically significant differences in OS and DFS between the two groups (all P>0.05). The analysis of risk factors revealed that only male gender was an independent risk factor for OS (HR=2.237, 95% CI=1.119-4.473, P=0.023), while timing of surgery and other factors showed no significant relationship with OS and DFS (all P>0.05). There were no statistically significant differences in operative time and length of hospital stay between the two groups (all P>0.05). Different time intervals for secondary hepatectomy had no significant impact on perioperative variables and prognosis of patients (all P>0.05).Conclusion For T1b/T2 stage GBC patients, secondary hepatectomy has a comparable impact on efficacy and long-term prognosis compared to one-stage hepatectomy. Moreover, different time intervals for secondary hepatectomy within a 4-week window do not significantly affect prognosis.