[Cholangiocellular cancer: the state of the problem and ways to improve the results of surgical treatment].

Autor:	Patyutko YI; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Polyakov AN; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Podluzhnyi DV; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Syskova AY; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Sagaidak IV; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Kotel'nikov AG; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Sergeeva ON; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia., Pokataev IA; N.N. Blokhin National Medical Cancer Research Center of Healthcare Ministry of the Russia, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Khirurgiia [Khirurgiia (Mosk)] 2018 (12), pp. 30-37.
DOI:	10.17116/hirurgia201812130
Abstrakt:	Aim: To improve the outcomes in patients with resectable biliary cancer. Material and Methods: There were 263 procedures for cholangiocellular carcinoma (CCC) for the period 1998—2017. Adjuvant chemotherapy was performed in 102 (38.8%) patients. Extensiveliver resections (78.9%) prevailed for intrahepatic cholangiocellular carcinoma (n=128), 6 (4.7%) patients required vascular resection. Seventy-seven pancreatoduodenectomies were performed for common bile duct cancer, portal vein resection was done in 8 (10.4%) patients. In case of Klatskin tumor (n=58) liver resection combined with bile duct resection (n=52) prevailed. Portal vein resection was done in 16 (27.6%) patients. Results: Postoperative morbidity in patients with intrahepatic CCC was revealed in 68 (53.1%) cases, mortality — in 5 (3.9%) cases. Among patients with Klatskin tumor morbidity was revealed in 51 (87.9%) cases, mortality — in 6 (10.3%) cases. In patients with common bile duct cancer morbidity was revealed in 53 (68.8%) cases, mortality — in 4 (5.2%) cases. In whole cohort median overall survival was 30 months. R0-resection was associated with better long-term results (median 37 months) compared with R1—R2 resection (20 months; p=0.01). Lymph node involvement is associated with significantly worse prognosis (p=0.016), however 5-year survival is observed (25.6%). Adjuvant chemotherapy in R0-resection significantly improved long-term results: median was 46 months (vs. 30 in group without chemotherapy; p=0.02). In intrahepatic CCC patients multiple lesions or mechanical jaundice did not aggravate long-term results. Conclusion: R0-resection including lymphadenectomy, resection of adjacent organs and vessels is advisable for CCC. Isolated bile duct resection should be used as an exception. Adjuvant therapy improved long-term results. Multiple lymph node lesion or bile duct infiltration are not contraindications to surgery in intrahepatic CCC patients.
Databáze:	MEDLINE
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