ABSTRACT
Objective:To analyse the risk factors of biliary leakage after surgical resection in patients with perihilar cholangiocarcinoma (PHCC).Methods:The medical data on 179 patients who underwent surgical resection for PHCC at the Department of Hepatopancreatobiliary Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo University from April 2000 to April 2020 were collected, and 160 patients were finally enrolled into this study. There were 86 males and 74 females, aged (63.4±10.8) years. The 44 patients with class B biliary leakage and the 5 patients with class C biliary leakage were classified into the biliary leakage group, while the remaining 111 patients were classified into the control group. Risk factors of biliary leakage were analysed by univariate and multivariate logistic regression analyses.Results:Operation time ≥360 min, resection and reconstruction of hepatic hilar vessels on the preserved side of liver and number of bile duct openings of >3 in remnant liver were significantly higher in the biliary leakage than the control group (all P<0.05). Multivariate analysis showed that resection and reconstruction of hepatic hilar vessels on the preserved side ( OR=2.322, 95% CI: 1.078-5.002, P=0.028) and 3 or more bile duct openings in the remnant liver ( OR=2.656, 95% CI: 1.198-5.892, P=0.016) were significantly associated with biliary leakage. Conclusion:Resection and reconstruction of hepatic hilar vessels on the preserved side of liver and 3 or more bile duct openings in remnant liver were independent risk factors for biliary leakage after PHCC resection.
ABSTRACT
Objective:To evaluate clinical and pathological factors related to the actual 5-year survival of patients with hilar cholangiocarcinoma (HCC).Methods:A total of 94 HCC patients who underwent radical surgery at the Department of Hepatobiliary and Pancreatic Surgery, Li Huili Hospital of Ningbo Medical Center from Jan 2000 to Jun 2015 were enrolled in this study.Patients were divided into two groups: postoperative survival group beyond 5 years and death group within 5 years. The clinical and pathological features of the two groups were analyzed.Results:Of the 94 patients, 19 (20.2%) had a postoperative survival time of more than 5 years. The actual 5-year overall survival rate of HCC patients (20.2%) was lower than that estimated by Kaplan-Meier survival analysis (22.2%). Gender, age, CEA value, CA199 value, total bilirubin, Child-Pugh classification, Bismuth classification and preoperative jaundice reduction were not significantly different between the two groups nor there were significant difference between two groups in operation time, blood loss, surgical procedure, combined caudate lobectomy, combined pancreaticoduodenectomy, combined resection of surrounding organs, vascular reconstruction and number of bile duct orifices in remnant liver surface. There were significant differences between two groups in the variables of pathological phenotype ( P=0.012), lymph node metastasis ( P=0.001) and resection level ( P=0.048). Conclusion:Non-papillary type, lymph node metastasis and R 1 resection are the independent risk factors of the actual 5-year survival.