Impact of postoperative morbidity on long ⁃ term oncologic outcomes after major liver resection for advanced perihilar cholangiocarcinoma
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摘要:
目的：探讨术后并发症与联合大范围肝切除治疗进展期肝门部胆管癌患者预后的相关性。方法：回顾性分析2008—2017年接受联合大范围肝切除与尾状叶切除术治疗肝门部胆管癌患者的临床资料。术后严重并发症定义为任何Clavien-Dindo Ⅲ或Ⅳ级并发症。 结果：共123例纳入研究，其中35例（28.5％）出现严重术后并发症。出现严重术后并发症和无严重术后并发症的5年疾病特异性生存率和无复发生存率分别为12.9％ vs. 40.2％（P=0.012）、0％ vs. 28.1％（P < 0.001）。多因素分析显示，严重术后并发症是无复发生存率的独立预测因素（风险比=1.87，P=0.043），但严重术后并发症不是疾病特异性生存率的独立预后因素。根据并发症严重程度分层的亚组分析显示了相似结果，出现轻度术后并发症与无并发症的患者长期生存相近。结论：联合大范围肝切除治疗肝门部胆管术后的严重并发症与患者的不良预后相关。因此，良好的术前准备和精细的手术操作对减少严重术后并发症、提高长期生存非常重要。
Abstract:
Objective：To determine the prognostic relevance of postoperative morbidity in advanced perihilar cholangiocarcinoma（PHC）. Methods：From 2008 to 2017，clinical data of patients undergoing major hepatectomy with caudate lobectomy for PHC were reviewed retrospectively. Severe morbidity was defined as any complication of Clavien-Dindo grade Ⅲ or Ⅳ. Results：A total of 123 patients were enrolled and severe morbidity occurred in 35 patients（28.4%）. The 5-year disease-specific survival and recurrence-free survival for those with and without severe morbidity were：12.9% versus 40.2%（P=0.012）and 0% versus 28.1%（P < 0.001），respectively. Multivariate analysis revealed that severe morbidity independently predicted decreased recurrence-free survival（hazard ratio=1.87，P=0.043）；however，severe morbidity did not emerge as an independent predictor of disease-specific survival. Subgroup analysis of patients stratified by morbidity grade showed similar results，while patients with minor morbidity showed similar survival to those without morbidity. Conclusion：Severe morbidity adversely affects survival outcomes following major liver resection for PHC；thus，optimal preoperative preparation and careful dissection are important to reduce postoperative complications and improve long-term survival.
