Feasibility of major hepatectomy following preoperative chemotherapy for advanced perihilar cholangiocarcinoma.

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2024-10-01 DOI:10.1016/j.ejso.2024.108733

Atsushi Takahashi, Ryuji Yoshioka, Shuichi Koike, Masahiro Fujisawa, Masaru Oba, Yoshinori Takeda, Yuki Fukumura, Yoshihito Kotera, Yoshihiro Mise, Akio Saiura

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引用次数: 0

Abstract

Background: The safety of major hepatectomy following preoperative chemotherapy for perihilar cholangiocarcinoma (PHCC) is underexplored. This study evaluates the impact of preoperative chemotherapy on surgical outcomes and assesses chemotherapy-induced liver injury in patients with advanced PHCC.

Methods: This retrospective study included 62 PHCC patients who underwent surgery between January 2019 and January 2024. Patients were divided into an upfront surgery group (UFS, n = 31) and a preoperative chemotherapy group (POC, n = 31). Preoperative chemotherapy was indicated when R0/R1 resection was unachievable, complex surgery was needed, or future liver reserve was insufficient. Baseline characteristics, surgical procedures, postoperative complications, and pathological findings were compared.

Results: Postoperative complications were comparable between groups, with Clavien-Dindo grade ≥3a rates of 30.7 % in the POC group and 24.3 % in the UFS group. Despite longer operative times and hospital stays in the POC group, no significant differences in hepatotoxicity or pathological findings, including Kleiner and Rubbia-Brandt scores, were observed. Notably, a pathological complete response was achieved in 12.9 % of the POC group.

Conclusion: Major hepatectomy following preoperative chemotherapy for PHCC is safe and does not increase the risk of postoperative complications or hepatotoxicity. Further studies are warranted to refine resectability criteria and optimize patient selection.

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晚期肝周胆管癌术前化疗后行大肝切除术的可行性。

背景：肝周胆管癌（PHCC）术前化疗后进行肝切除术的安全性尚未得到充分探讨。本研究评估了术前化疗对手术结果的影响，并对晚期 PHCC 患者化疗引起的肝损伤进行了评估：这项回顾性研究纳入了在2019年1月至2024年1月期间接受手术的62例PHCC患者。患者被分为前期手术组（UFS，n = 31）和术前化疗组（POC，n = 31）。术前化疗适用于无法实现R0/R1切除、需要复杂手术或未来肝储备不足的情况。对基线特征、手术过程、术后并发症和病理结果进行了比较：两组术后并发症的发生率相当，POC组Clavien-Dindo分级≥3a的发生率为30.7%，UFS组为24.3%。尽管 POC 组的手术时间和住院时间更长，但在肝毒性或病理结果（包括 Kleiner 和 Rubbia-Brandt 评分）方面没有观察到显著差异。值得注意的是，POC 组中有 12.9% 的患者获得了病理完全反应：结论：PHCC 术前化疗后进行肝切除术是安全的，不会增加术后并发症或肝毒性的风险。有必要开展进一步研究，以完善可切除性标准，优化患者选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.