Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus A Korea-Japan Multicenter Study

被引：48

作者：

Kim, Dong-Sik ^{[1
]}

Kim, Bong-Wan ^{[2
]}

Hatano, Etsuro ^{[3
]}

Hwang, Shin ^{[4
]}

Hasegawa, Kiyoshi ^{[5
,6
]}

Kudo, Atsushi ^{[7
]}

Ariizumi, Shunichi ^{[8
]}

Kaibori, Masaki ^{[9
]}

Fukumoto, Takumi ^{[10
]}

Baba, Hideo ^{[11
]}

Kim, Seong Hoon ^{[12
]}

Kubo, Shoji ^{[13
]}

Kim, Jong Man ^{[14
]}

Ahn, Keun Soo ^{[15
]}

Choi, Sae Byeol ^{[1
]}

Jeong, Chi-Young ^{[16
]}

Shima, Yasuo ^{[17
]}

Nagano, Hiroaki ^{[18
]}

Yamasaki, Osamu ^{[19
]}

Yu, Hee Chul ^{[20
]}

Han, Dai Hoon ^{[21
]}

Seo, Hyung-Il ^{[22
]}

Park, Il-Young ^{[23
]}

Yang, Kyung-Sook ^{[24
]}

Yamamoto, Masakazu ^{[8
]}

Wang, Hee-Jung ^{[2
]}

机构：

[1] Korea Univ, Dept Surg, Coll Med, Seoul, South Korea

[2] Ajou Univ, Dept Surg, Sch Med, 164 World Cup Ro, Suwon 16499, South Korea

[3] Kyoto Univ, Grad Sch Med, Dept Surg, Kyoto, Japan

[4] Univ Ulsan, Asan Med Ctr, Dept Surg, Coll Med, Seoul, South Korea

[5] Univ Tokyo, Grad Sch Med, Dept Surg, Hepatobiliary Pancreat Surg Div, Tokyo, Japan

[6] Univ Tokyo, Grad Sch Med, Dept Surg, Artificial Organ & Transplantat Div, Tokyo, Japan

[7] Tokyo Med & Dent Univ, Grad Sch Med, Dept Hepatobiliary Pancreat Surg, Tokyo, Japan

[8] Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan

[9] Kansai Med Univ, Dept Surg, Hirakata Hosp, Osaka, Japan

[10] Kobe Univ, Dept Surg, Div Hepatobiliary Pancreat Surg, Grad Sch Med, Kobe, Hyogo, Japan

[11] Kumamoto Univ, Dept Gastroenterol Surg, Grad Sch Life Sci, Kumamoto, Japan

[12] Natl Canc Ctr, Ctr Liver Canc, Ilsan, South Korea

[13] Osaka City Univ, Dept Hepatobiliary Pancreat Surg, Grad Sch Med, Osaka, Japan

[14] Sungkyunkwan Univ, Samsung Med Ctr, Dept Surg, Sch Med, Seoul, South Korea

[15] Keimyung Univ, Dept Surg, Dongsan Med Ctr, Daegu, South Korea

[16] Gyeongsang Natl Univ, Coll Med, Dept Surg, Jinju, South Korea

[17] Kochi Hlth Sci Ctr, Dept Gastroenterol Surg, Koichi, Japan

[18] Osaka Univ, Grad Sch Med, Dept Gastroenterol Surg, Osaka, Japan

[19] Osaka City Juso Hosp, Dept Surg, Osaka, Japan

[20] Chonbuk Natl Univ, Dept Surg, Med Sch, Jeonju, South Korea

[21] Yonsei Univ, Dept Surg, Coll Med, Seoul, South Korea

[22] Pusan Natl Univ, Dept Surg, Coll Med, Busan, South Korea

[23] Catholic Univ Korea, Dept Surg, Bucheon St Mary Hosp, Bucheon, South Korea

[24] Korea Univ, Dept Biostat, Coll Med, Seoul, South Korea

来源：

ANNALS OF SURGERY | 2020年 / 271卷 / 05期

关键词：

bile duct resection; jaundice; liver resection; prognosis; survival; thrombectomy; OBSTRUCTIVE-JAUNDICE; BILIARY OBSTRUCTION; SURGERY; CLASSIFICATION; COMPLICATIONS; DIAGNOSIS; INVASION;

D O I：

10.1097/SLA.0000000000003014

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT). Summary Background Data: Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports. Methods: Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model. Results: Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P< 0.001) and the presence of fibrosis/cirrhosis (P= 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99);P= 0.044 and HR = 0.51 (0.31-0.84);P= 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91);P= 0.018 and HR = 0.61 (0.42-0.89);P= 0.009, respectively]. Conclusions: Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.

引用

页码：913 / 921

页数：9

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