Analysis of the curative effect and prognosis factors of surgical treatment for hilar cholangiocarcinoma / 国际外科学杂志

ABSTRACT

Objective To exlore and analyze the curative effect and pognostic factors of surgical treatment for hilar cholangiocarcinoma.Methods The clinical data and prognosis of 92 patients with hilar cholangiocarcinoma admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2010 to January 2018 were retrospectively analyzed.There were 58 males and 34 females,with an age range of 35-81 years and average age of 61.3 years.Among them,50 patients underwent radical resection of tumors (radical operation group),and 42 patients were discussed to undergo radical operation before operation,but only palliative resection of tumors or simple biliary drainage (palliative operation group) were performed because of the high location of tumors or distant metastasis during operation.Of the 50 patients who received radical surgery,27 underwent simple perihepatic portectomy (perihepatic hilar resection group),and 23 underwent combined hepatic lobectomy (extended hepatectomy group).The incidence of perioperative complications,perioperative mortality and long-term survival rate of all patients were collected.The data of clinical cases included in the study were analyzed by univariate and multivariate analysis,and the relationship between perioperative mortality and prognosis survival time was discussed.The measurement data that accord with normal distribution were expressed by (Mean ± SD).The comparison between the two groups was performed by t-test,the comparison between multiple groups was performed by one-way ANOVA;Measurement data with non-normal distribution were described as M(P25,P75),and comparison between groups was done using Mann-Whitney U test.The comparison between counting data groups was performed by chi-square test.Results Ninety-two patients included in this study successfully completed the operation.One patient died during the perioperative period,with a mortality rate of 1.09％.The incidence of complications was 35.87％.Biliary tract infection and bile leakage were the most common complications.The incidence of complications was 14.13％ (13/92) and 9.78％ (9/92) respectively.The survival time of patients in the radical operation group 34.23(13.00,52.25) months was significantly different from that in the palliative operation group 4.75 (2.88,7.25) months (Z =-6.708,P =0.000).There was no significant difference in the survival time between the extended hepatectomy group 33.87 (13.00,56.00) months and the simple perihepatectomy group 34.54 (13.00,51.00) months (Z =-0.156,P =0.876).Univariate analysis showed that the factors related to the prognosis of hilar cholangiocarcinoma were preoperative history of calculi,tumor size,preoperative highest serum total bilirubin level,preoperative CA19-9 level,surgical modality ard tumor differentiation(HR =0.200,2.692,2.942,4.350,3.740,0.198;95％ CI0.043-0.938,0.995-7.283,1.022-8.469,1.174-16.114,1.229-11.382,0.049 ～ 0.806,P ＜ 0.05).Multivariate analysis showed that tumor size,tumor differentiation and surgical modality were related to hilar cholangiocarcinoma.Surgical prognosis of patients with cholangiocarcinoma was significantly correlated (OR =1.034,6.444,12.527;95 ％ CI1.007-1.062,1.012-41.037,3.187-49.243,P ＜0.05).Conclusions Radical resection is an effective way to improve the survival of patients with hilar cholangiocarcinoma.The effective grasp of surgical indications can improve the overall treatment prognosis.