フルカワ トオル   FURUKAWA Tooru
  古川 徹
   所属   医学部 医学科(東京女子医科大学病院)
   職種   客員教授
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