肝门周围胆管癌探查性手术后不切除的结果：一项全国性分析

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-08-27 DOI:10.1016/j.ejso.2025.110419

Julien A. Luyten , Lydia G. van der Geest , Steven W.M. Olde Damink , Frank G. Schaap , Bas Groot Koerkamp , Marjolein Y.V. Homs , Joris I. Erdmann , Willem F. Brandts , Joanne Verheij , Frederik J.H. Hoogwater , Jeroen Hagendoorn , Jelmer E. Oor , Robert C. Verdonk , Iryna V. Samarska , Razvan L. Miclea , Jan Bednarsch , Ulf P. Neumann , Judith de Vos-Geelen , Maxime J.L. Dewulf , Dutch Hepatocellular and Cholangiocarcinoma Group

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引用次数: 0

摘要

肝门周围胆管癌（pCCA）可切除性的明确评估通常需要手术探查。关于不切除的手术探查是否会影响后续全身治疗和生存的数据有限。这项全国性的分析旨在解决这个问题。方法2012年至2023年间诊断为非转移性pCCA的患者从荷兰癌症登记处选择，并将其分类为切除，探查（手术探查而不切除）或非探查（非转移性肿瘤，不探查或切除）。总体生存数据根据全身治疗的使用进行分层。结果纳入2014例患者，其中490例（24.3%）行肿瘤切除术，258例（12.8%）行未切除手术探查，1266例（62.9%）未探查。总体而言，探查后90天死亡率为19.5%。在调查的患者中，38.0%（98/258）接受了全身治疗，而未调查的患者为10.6% (134/1266)（p < 0.001）。通过全身治疗，探查患者自诊断起的中位总生存期（mOS）为14.3个月（95% CI 12.7-18.2），而未探查患者的中位总生存期为12.8个月（95% CI 11.6-15.8）（p = 0.350）。在最佳支持治疗下，探查患者的生存期为8.1个月（95% CI 6.5-10.3），而未探查患者的生存期为3.2个月（95% CI 2.8-3.7）（p≤0.001）。结论在接受全身治疗的非转移性pCCA患者中，接受手术探查和不接受手术探查的患者的生存结果是相似的。尽管可能影响生活质量，但这些研究结果表明，手术探查并不妨碍获得全身治疗或对生存产生负面影响。

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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Outcomes following exploratory surgery without subsequent resection in perihilar cholangiocarcinoma: A nationwide analysis

Introduction

Definitive assessment of resectability in perihilar cholangiocarcinoma (pCCA) often requires surgical exploration. Limited data exist on whether surgical exploration without resection affects the chance of receiving subsequent systemic therapy and survival. This nationwide analysis aims to address this question.

Methods

Patients diagnosed with non-metastatic pCCA between 2012 and 2023 were selected from the Netherlands Cancer Registry and categorized as resected, explored (surgical exploration without resection), or non-explored (non-metastatic tumours without exploration or resection). Overall survival data was stratified by systemic therapy use.

Results

The cohort included 2014 patients of which 490 patients (24.3 %) underwent resection, 258 patients (12.8 %) underwent surgical exploration without resection, and 1266 patients (62.9 %) were not explored. Overall, 90-day mortality following exploration was 19.5 %. Among explored patients, 38.0 % (98/258) received systemic therapy compared to 10.6 % (134/1266) of non-explored patients (p < 0.001). With systemic therapy, explored patients had a median overall survival (mOS) of 14.3 months (95 % CI 12.7–18.2) from diagnosis compared to 12.8 months (95 % CI 11.6–15.8) for non-explored patients (p = 0.350). With best supportive care, explored patients had a mOS of 8.1 months (95 % CI 6.5–10.3) compared to 3.2 months (95 % CI 2.8–3.7) for non-explored patients (p ≤ 0.001).

Conclusion

Among patients with non-metastatic pCCA receiving systemic therapy, survival outcomes are comparable between those who undergo surgical exploration and those who do not. Despite a possible impact on quality of life, these findings suggest that surgical exploration does not hinder access to systemic therapy or negatively affect survival.

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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.