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A.N. Polyakov
Blokhin National Medical Research Center of Oncology
Yu.I. Patyutko
Blokhin National Medical Research Center of Oncology
Surgical treatment and prognostic factors in perihilar tumors
Journal: Pirogov Russian Journal of Surgery. 2024;(2): 14‑23
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To cite this article:
Polyakov AN, Patyutko YuI, Kotelnikov AG, Frantsev DYu, Korshak AV, Uzbekova AA, Egenov OA, Pokataev IA, Savchenko IV, Podluzhnyi DV. Surgical treatment and prognostic factors in perihilar tumors. Pirogov Russian Journal of Surgery.
2024;(2):14‑23. (In Russ., In Engl.)
https://doi.org/10.17116/hirurgia202402114
To study the results of surgical treatment in patients with perihilar tumors.
We analyzed 98 patients with perihilar tumors who underwent surgery.
We prefer percutaneous transhepatic biliary drainage (n=58) for jaundice. Retrograde interventions were performed in 18 cases (20.5%), complications grade III—IV were more common (p=0.037) in the last group. Postoperative mortality was 12%. Complications developed in 81 patients (82.7%), grade ≥3 — in 39 (39.8%) cases. Portal vein resection (n=26) increased the incidence of complications grade ≥III (p=0.035) and portal vein thrombosis (p=0.0001). Chemotherapy after surgery was performed in 47 patients (48.0%), photodynamic therapy — in 7 (7.1%) patients. A 5-year overall survival was 28.1%, the median survival — 29 months. R2 resection and/or M1 stage (n=12) significantly worsened the prognosis and overall survival (16.5 vs. 31 months, p=0.0055). Lymph node (LN) lesion, microscopic status (R0 vs. R1) of resection margin, technique of decompression and isolated resection of extrahepatic bile ducts did not affect the prognosis, and we combined appropriate patients (n=72) for analysis. SI resection and excision of ≥6 lymph nodes were independent positive factors for disease-free survival (p=0.042 and p=0.007, respectively). Blood transfusion and high preoperative neutrophil-lymphocyte index (NLI ≥2.15) worsened overall (p=0.009 and p=0.002, respectively) and disease-free survival (p=0.002 and 0.007, respectively). The absence of adjuvant therapy worsened disease-free survival alone (p=0.024).
SI liver resection, adequate lymph node dissection and adjuvant therapy should be used for perihilar tumors. Isolated resection of extrahepatic bile ducts is permissible in some cases. Blood transfusion and NLI ≥2.15 are independent negative prognostic factors.
Keywords:
Authors:
A.N. Polyakov
Blokhin National Medical Research Center of Oncology
Yu.I. Patyutko
Blokhin National Medical Research Center of Oncology
Received:
01.08.2023
Accepted:
10.09.2023
List of references:
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