ウエムラ　シユウイチロウ   Uemura Shiyuuichirou   植村　修一郎    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion.
掲載誌名	正式名：Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 略　 称：J Gastrointest Surg ISSNコード：18734626/1091255X
巻・号・頁	23(7),pp.1443-1453
著者・共著者	Higuchi Ryota, Yazawa Takehisa, Uemura Shuichiro, Izumo Wataru, Ota Takehiro, Kiyohara Kosuke, Furukawa Toru, Egawa Hiroto, Yamamoto Masakazu
発行年月	2019/07
概要	PURPOSE:To investigate short- and long-term surgical outcomes for patients with perihilar cholangiocarcinoma and vascular invasion.METHODS:Data from 249 patients who underwent perihilar cholangiocarcinoma surgery between 2000 and 2016 were retrospectively analyzed. Patient evaluations included short-term surgical outcomes following vascular resection and long-term outcomes in cases with histopathological vascular invasion.RESULTS:Mortality was 3.6% overall; 16% for hepatic artery resections, 5.4% for portal vein resections, and 1.7% in the absence of vascular resection (p = 0.029). No between-group differences were observed in the incidence of Clavien-Dindo grade ≥ 3 complications. The factors related to perioperative mortality were hepatic artery resection (odds ratio [OR] = 25.5), right trisectionectomy (OR = 13.0), and central bisectionectomy (OR = 13.8). Multivariate analysis for overall survival identified several prognostic factors: carcinoembryonic antigen level ≥ 5 ng/mL (hazard ratio [HR] = 1.68), poor differentiation (HR = 2.39), distant metastasis (HR = 1.97), and R1 invasive resection (HR = 2.13). Five-year overall survival for patients with portal vein invasion and M0R0/1cis was 35.6%, significantly worse than the 53.4% for patients with no portal vein invasion and M0R/1cis but better than the 0% for patients with portal vein invasion and M1 or R1. Those with hepatic arterial invasion and M0R0/1cis were 24.7%, significantly worse than the 53.4% for patients with no hepatic arterial invasion and M0R0/1cis but significantly better than the 0% for patients with hepatic arterial invasion and M1 or R1.CONCLUSION:Short-term outcomes for patients with perihilar cholangiocarcinoma and undergoing vascular resection were poor compared to those without vascular resection. Long-term survival in R0M0 disease was more favorable; aggressive surgery is recommended.
DOI	10.1007/s11605-018-3948-x
PMID	30203230