多灶性肝内胆管癌的外科治疗。

IF 1.2 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Augustė Andzelytė, Ieva Tveragaitė, Povilas Ignatavicius
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引用次数: 0

摘要

多灶性肝内胆管癌(m-ICC)是原发性肝癌的一种侵袭性形式,通常伴有不良预后。虽然手术切除被认为是ICC的唯一治疗方法,但由于复发风险高和生存获益有限,多灶性常被视为禁忌。目的对m-iCCA的手术治疗结果进行系统的文献综述。方法按照PRISMA标准进行系统评价。该综述的研究方案已在国际前瞻性系统综述注册数据库中注册。系统检索数据库,分析m-iCCA手术治疗结果的研究。结果纳入10篇文献,共2392例m-ICCA患者。回顾的研究报告了广泛的外科手术,中位生存期从18.9到27个月不等。m-iCCA患者的复发率(67.8-74.3%)高于单独ICC患者(52.4-60.5%),无复发生存期短至4.5个月。一项研究报告手术患者的5年生存率为12.9%,而非手术患者的5年生存率为0%。生存结果受不良预后指标的影响。结论手术切除多灶性肝内胆管癌是一种具有挑战性的治疗选择,因为这种疾病的复发可能性很高,而且具有侵袭性。尽管存在这些挑战,手术可能会为精心挑选的患者提供生存益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgery for Multifocal Intrahepatic Cholangiocarcinoma.

Introduction: Multifocal intrahepatic cholangiocarcinoma (m-iCCA) is a complex and aggressive form of primary liver cancer, often associated with poor outcomes. Although surgical resection is considered the only curative treatment for intrahepatic cholangiocarcinoma (iCCA), multifocality is frequently regarded as a contraindication due to the high risk of recurrence and limited survival benefits. Advances in surgical techniques and evolving treatment strategies have reopened discussions about the feasibility of resection in these cases.

Methods: We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. We systematically searched PubMed, Web of Science, MEDLINE, and ScienceDirect databases up to July 30, 2024, for studies analyzing surgical treatment outcomes for m-iCCA. We assessed the quality of the included studies according to the Newcastle-Ottawa Scale (NOS).

Results: After our initial search, 2,482 articles were found related to this topic and 381 articles were left for screening. We checked each article against the eligibility criteria and selected for the full-text analysis. Ten articles with 2,392 patients who had m-iCCA were included in our review. The reviewed studies reported extensive surgical procedures, such as extended hemihepatectomy and associating liver partition and portal vein ligation for staged hepatectomy, with median survival ranging from 18.9 to 27 months. Recurrence rates were higher in m-iCCA patients (67.8-74.3%) compared to solitary iCCA cases (52.4-60.5%), with recurrence-free survival as short as 4.5 months. Adjuvant chemotherapy was frequently used, although its effectiveness in terms of survival was inconsistent. One study reported a 5-year survival rate of 12.9% for surgical patients compared to 0% for non-operated patients. Survival outcomes were influenced by adverse prognostic indicators such as lymph node metastases and perineural invasion.

Conclusion: Surgical resection for m-iCCA, while associated with high recurrence rates (67.8-74.3%), provides a survival advantage over nonsurgical management (median overall survival: 18.9-27 months vs. 8 months; 5-year survival: 12.9% vs. 0%) for carefully selected patients. More studies are needed to improve patient selection and refine treatment approaches to enhance long-term outcomes.

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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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