AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2...AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.展开更多
AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Ka...AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed.Kasai portoenterostomy with the placement of biliary stents was performed in all patients.Clinical characteristics,postoperative complications,and long-term outcomes were analyzed.All patients were followed up for 2-60 mo postoperatively.RESULTS:Patients were classified according to the Bismuth classification of biliary strictures.There were two Bismuth Ⅲ and eight Bismuth Ⅳ lesions.Six lesions were benign and four were malignant.Of the benign lesions,three were due to post-cholecystectomy injury,one to trauma,one to inflammation,and one to inflammatory pseudotumor.Of the malignant lesions,four were due to hilar cholangiocarcinoma.All patients underwent Kasai portoenterostomy with the placement of biliary stents.There were no perioperative deaths.One patient experienced anastomotic leak and was managed conservatively.No other complications occurred perioperatively.During the follow-up period,all patients reported a good quality of life.CONCLUSION:The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.展开更多
Objective: To evaluate the outcome of radiotherapy (RT) in locally advanced hepatic hilar cholangiocarcinoma. Methods: During March 1992 to December 1997, 47 patients who had positive microscopic surgical margins afte...Objective: To evaluate the outcome of radiotherapy (RT) in locally advanced hepatic hilar cholangiocarcinoma. Methods: During March 1992 to December 1997, 47 patients who had positive microscopic surgical margins after surgery were treated by postoperative radiotherapy (S+RT, 28 patients, with a median dose of 50 Gy, 45–62 Gy) and surgery alone (S, 19 patients). The median follow-up was 30 months (4–113 months). Results: The overall 5-year survival rate was 28%, with a median survival length of 19.6 months while 5-year survival rates of S+RT group and S group were 34% and 14%, with median survival lengths of 29 and 10 months respectively (P=0.015). The occurrence rate of complications was 11% in either group. Conclusion: Postoperative radiotherapy significantly prolongs survival lengths in patients with hepatic hilar cholangio- carcinoma who had positive microscopic surgical margins. Radiation toxicities are tolerable.展开更多
AIM： To evaluate hepatic recurrence and prognostic factors for survival in patients with surgically resected hilar cholangiocarcinoma in a single institution over the last 13 years. METHODS： From 1994 to 2007, all p...AIM： To evaluate hepatic recurrence and prognostic factors for survival in patients with surgically resected hilar cholangiocarcinoma in a single institution over the last 13 years. METHODS： From 1994 to 2007, all patients with hilar cholangiocarcinoma referred to a surgical clinic were evaluated. Demographic data, tumor characteristics, and outcome were analyzed retrospectively. Outcome was compared in patients who underwent additional liver resection with resection of the tumor. RESULTS： Of the 69 patients submitted to laparotomy for tumor resection, curative resection （Ro resection） was performed in 40 patients, and palliative resection in 29. Thirty-one patients had only duct resection, and 38 patients had combined duct resection with liver resection including 34 total or part caudate lobes. Curative rates with the combined hepatectomy were significantly improved compared with those without additional hepatectomy （27/38 vs 13/31; X^2 = 5.94, P 〈 0.05）. Concomitant liver resection was associated with a decreased incidence of initial recurrence in liver one year after surgery （11/38 vs 23/31; X^2 = 13.98, P 〈 0.01）. The 3-year survival rate after Ro resection was 30.7% and was 10.5% for palliative resection. R0 resection improved the 3-year survival rate （30.7% vs 10.5%; X^2 = 12.47, P 〈 0.01）.CONCLUSION： Hepatectomy, especially including the caudate lobe combined with bile duct resection should be considered standard treatment to cure hilar cholangiocarcinoma.展开更多
Background:Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma(pCCA)after resection.The objective of our study was to construct a useful scoring syste...Background:Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma(pCCA)after resection.The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy.Methods:In total,244 patients who underwent radical resection for type IV pCCA were included.Data on clinicopathological characteristics,perioperative details and survival outcomes were analyzed.Survival curves were generated using the Kaplan–Meier method.Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence.Results:Twenty-one months was defined as the cutoff point to distinguish between early and late recurrence.Univariate and multivariate analysis revealed that CA19-9 level>200 U/mL,R1 resection margin,higher N category and positive lymphovascular invasion were independent predictors of early recurrence.The scoring system was constructed accordingly.The early-recurrence rates of patients with scores of 0,1,2,3,4,and 5 were 23.9%,38.7%,60.0%,78.6%,83.4%,and 100%,respectively.Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence,but not for those with late recurrence.Patients in the early-recurrence group with scores2 had better prognoses after adjuvant therapy.Conclusions:A simple scoring system using CA19-9 level,N category,resection margin and lymphovascular invasion status could predict early recurrence,and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.展开更多
文摘AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.
文摘AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed.Kasai portoenterostomy with the placement of biliary stents was performed in all patients.Clinical characteristics,postoperative complications,and long-term outcomes were analyzed.All patients were followed up for 2-60 mo postoperatively.RESULTS:Patients were classified according to the Bismuth classification of biliary strictures.There were two Bismuth Ⅲ and eight Bismuth Ⅳ lesions.Six lesions were benign and four were malignant.Of the benign lesions,three were due to post-cholecystectomy injury,one to trauma,one to inflammation,and one to inflammatory pseudotumor.Of the malignant lesions,four were due to hilar cholangiocarcinoma.All patients underwent Kasai portoenterostomy with the placement of biliary stents.There were no perioperative deaths.One patient experienced anastomotic leak and was managed conservatively.No other complications occurred perioperatively.During the follow-up period,all patients reported a good quality of life.CONCLUSION:The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.
文摘Objective: To evaluate the outcome of radiotherapy (RT) in locally advanced hepatic hilar cholangiocarcinoma. Methods: During March 1992 to December 1997, 47 patients who had positive microscopic surgical margins after surgery were treated by postoperative radiotherapy (S+RT, 28 patients, with a median dose of 50 Gy, 45–62 Gy) and surgery alone (S, 19 patients). The median follow-up was 30 months (4–113 months). Results: The overall 5-year survival rate was 28%, with a median survival length of 19.6 months while 5-year survival rates of S+RT group and S group were 34% and 14%, with median survival lengths of 29 and 10 months respectively (P=0.015). The occurrence rate of complications was 11% in either group. Conclusion: Postoperative radiotherapy significantly prolongs survival lengths in patients with hepatic hilar cholangio- carcinoma who had positive microscopic surgical margins. Radiation toxicities are tolerable.
基金Professor Development Fund of Fujian Medical University
文摘AIM： To evaluate hepatic recurrence and prognostic factors for survival in patients with surgically resected hilar cholangiocarcinoma in a single institution over the last 13 years. METHODS： From 1994 to 2007, all patients with hilar cholangiocarcinoma referred to a surgical clinic were evaluated. Demographic data, tumor characteristics, and outcome were analyzed retrospectively. Outcome was compared in patients who underwent additional liver resection with resection of the tumor. RESULTS： Of the 69 patients submitted to laparotomy for tumor resection, curative resection （Ro resection） was performed in 40 patients, and palliative resection in 29. Thirty-one patients had only duct resection, and 38 patients had combined duct resection with liver resection including 34 total or part caudate lobes. Curative rates with the combined hepatectomy were significantly improved compared with those without additional hepatectomy （27/38 vs 13/31; X^2 = 5.94, P 〈 0.05）. Concomitant liver resection was associated with a decreased incidence of initial recurrence in liver one year after surgery （11/38 vs 23/31; X^2 = 13.98, P 〈 0.01）. The 3-year survival rate after Ro resection was 30.7% and was 10.5% for palliative resection. R0 resection improved the 3-year survival rate （30.7% vs 10.5%; X^2 = 12.47, P 〈 0.01）.CONCLUSION： Hepatectomy, especially including the caudate lobe combined with bile duct resection should be considered standard treatment to cure hilar cholangiocarcinoma.
基金This work was supported by the grants from the Science and Technology Support Project of Sichuan Province[No.2018SZ0170 and No.2018SZ0195].
文摘Background:Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma(pCCA)after resection.The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy.Methods:In total,244 patients who underwent radical resection for type IV pCCA were included.Data on clinicopathological characteristics,perioperative details and survival outcomes were analyzed.Survival curves were generated using the Kaplan–Meier method.Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence.Results:Twenty-one months was defined as the cutoff point to distinguish between early and late recurrence.Univariate and multivariate analysis revealed that CA19-9 level>200 U/mL,R1 resection margin,higher N category and positive lymphovascular invasion were independent predictors of early recurrence.The scoring system was constructed accordingly.The early-recurrence rates of patients with scores of 0,1,2,3,4,and 5 were 23.9%,38.7%,60.0%,78.6%,83.4%,and 100%,respectively.Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence,but not for those with late recurrence.Patients in the early-recurrence group with scores2 had better prognoses after adjuvant therapy.Conclusions:A simple scoring system using CA19-9 level,N category,resection margin and lymphovascular invasion status could predict early recurrence,and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.
