Pancreatoduodenectomy with portal vein resection for distal cholangiocarcinoma
| Autor: | T Maeta, T Ebata, E Hayashi, T Kawahara, S Mizuno, N Matsumoto, S Ohta, M Nagino, T Aoba, Y Kaneoka, T Arai, Y Shimizu, M Kiriyama, E Sakamoto, H Miyake, D Takara, K Shirai, S Ohira, N Morofuji, A Akutagawa, R Yamaguchi, M Takano, H Yamamoto, M Inoue, Y Asaba, T Watanabe, M Hashimoto, S Kawai, K Ikuta, H Matsubara, K Kato, S Kondo |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Surgical margin Blood transfusion Lymphovascular invasion medicine.medical_treatment Operative Time Perineural invasion Blood Loss Surgical 030230 surgery Pancreaticoduodenectomy Cholangiocarcinoma 03 medical and health sciences 0302 clinical medicine Japan medicine Humans Clinical significance Blood Transfusion Neoplasm Invasiveness Aged Retrospective Studies Aged 80 and over business.industry Portal Vein Age Factors Margins of Excision Retrospective cohort study Middle Aged Surgery medicine.anatomical_structure Bile Duct Neoplasms 030220 oncology & carcinogenesis Lymphatic Metastasis Multivariate Analysis Female Pancreas business Follow-Up Studies |
| Zdroj: | The British journal of surgery. 104(11) |
| ISSN: | 1365-2168 |
| Popis: | Background Little is known about the value of portal vein (PV) resection in distal cholangiocarcinoma. The aim of this study was to evaluate the clinical significance of PV resection in distal cholangiocarcinoma. Methods Patients who underwent pancreatoduodenectomy (PD) for distal cholangiocarcinoma between 2001 and 2010 at one of 31 hospitals in Japan were reviewed retrospectively with special attention to PV resection. Short- and long-term outcomes were evaluated. Results In the study interval, 453 consecutive patients with distal cholangiocarcinoma underwent PD, of whom 31 (6·8 per cent) had combined PV resection. The duration of surgery (510 versus 427 min; P = 0·005) and incidence of blood transfusion (48 versus 30·7 per cent; P = 0·042) were greater in patients who had PV resection than in those who did not. Postoperative morbidity and mortality were no different in the two groups. Several indices of tumour progression, including high T classification, lymphatic invasion, perineural invasion, pancreatic invasion and lymph node metastasis, were more common in patients who had PV resection. Consequently, the incidence of R1/2 resection was higher in this group (32 versus 11·8 per cent; P = 0·004). Survival among the 31 patients with PV resection was worse than that for the 422 patients without PV resection (15 versus 42·4 per cent at 5 years; P < 0·001). Multivariable analyses revealed that age, blood loss, histological grade, perineural invasion, pancreatic invasion, lymph node metastasis and surgical margin were independent risk factors for overall survival. PV resection was not an independent risk factor. Conclusion PV invasion in distal cholangiocarcinoma is associated with locally advanced disease and several negative prognostic factors. Survival for patients who have PV resection is poor even after curative resection. |
| Databáze: | OpenAIRE |
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