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Objective:To analyze the surgical efficacy and prognosis of supraduodenal distal cholangiocarcinoma (SDC) and Bismuth-Corlette type I hilar cholangiocarcinoma (BIC), and to explore the clinical characteristics of cholangiocarcinoma at different sites.Methods:The clinical data of 33 patients with SDC and 25 patients with BIC undergoing surgical treatment at the First Affiliated Hospital of Anhui Medical University from Jan 2009 to Dec 2016 were analyzed retrospectively.Results:In the BIC group, four patients (16.0%) had combined caudate lobectomy, while in SDC group no caudate lobectomy was needed ( P=0.030). The incidence of pancreatic fistulae in SDC group and BIC group was 18.2% (6/33) and 0 (0/25), respectively ( P=0.032). The cumulative survival rates 1, 3, and 5 years after operation were 94.0%, 54.5%, and 30.3% in SDC group and 88.0%, 28.0%, and 16.0% in BIC group, respectively ( P=0.045). Univariate analysis showed that location of cholangiocarcinoma, residual status and AJCC stage were correlated with postoperative prognosis of cholangiocarcinoma patients. Multivariate analysis showed that BIC, non-R 0 resection and AJCC stage Ⅲ/Ⅳ were independent risk factors for overall survival after surgery. Conclusion:The overall survival rate of SDC patients after radical surgical resection was significantly higher than that of the BIC group.
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Objective:To analyze the efficacy and prognosis of different surgical treatments for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA).Methods:The clinical data of 86 Bismuth-Corlette type III and IV HCCA patients treated at the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were retrospectively analyzed. There were 45 males and 41 females with age of (59.5±10.5) years old. According to the operative method, 57 patients were included into the extended hepatectomy group, and 29 patients into the perihilar hepatectomy group. The perioperative clinical data and survival rates were compared between the two groups. Through inpatient interviews, regular outpatient or telephone follow-up, factors affecting prognosis were analyzed by univariate and multifactorial Cox regression.Results:The operative time and intraoperative blood loss in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group, [320(270, 380) min vs. 270(210, 300) min, P<0.001; 300(200, 400) ml vs. 100(100, 150) ml, respectively P<0.001]. The incidences of ≥ Clavien-Dindo grade III complications and ISGLS grade C liver failure in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group [36.4%(20/57) vs. 13.8% (4/29), P=0.037; 13.8% (7/57) vs. 0(0/29), respectively P=0.047]. The cumulative 1-, 3- and 5-year survival rates of the extended hepatectomy group were 89.5%, 38.6% and 19.3%, respectively. The cumulative 1-, 3- and 5-year survival rates of perihilar hepatectomy group were 86.2%, 20.7% and 10.3%, respectively. The difference between the two groups was statistically significant ( P=0.048). Multivariate analysis showed that perihilar hepatectomy ( HR=1.958, 95% CI: 1.174-3.268, P=0.010), non-R 0 resection ( HR=6.040, 95% CI: 2.915-12.513, P<0.001) and TNM stage III/IV( HR=2.144, 95% CI: 1.257-3.654, P=0.005) were independent risk factors for overall survival after surgery for HCCA patients ( P<0.01). Conclusions:Patients with Bismuth-Corlette type III and IV HCCA who received extended hepatectomy had significantly better overall survival than those patients who underwent perihilar hepatectomy. However, the incidences of surgical complications and liver failure in the extended hepatectomy group were also significantly higher.
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Objective To investigate the prognoses of patients with ruptured hepatocellular carcinoma (HCC) after resection combined with interventional therapy.Methods This retrospective study was conducted on 50 consecutive patients with ruptured hepatocellular carcinoma treated from March 2013 to December 2016 in the First Affiliated Hospital,Anhui Medical University.The patients were divided into two groups according to the different therapies,they underwent:Group A resection after interventional therapy (n =20) and Group B interventional therapy after resection (n =40).The COX regression multivariate analysis was performed and the 1-year,2-year,3-year overall survival rates (OS) were calculated.Results The 3-year OS rates were significantly different (OS:34％ vs.0％,P =0.044).Multivariate survival analysis showed that age (HR 1.376,P ＜0.001,95％ CI 1.191 ～ 1.589) and blood transfusion (HR 1.001,P ＜ 0.05,95％ CI 1.000 ～ 1.003) were the two prognostic factors which affected OS rates of patients.Conclusions Combined surgical resection and interventional therapy was effective in treating patients with ruptured hepatocellular carcinoma.Resection after interventional therapy gave a better overall survival rate than interventional therapy after resection.