肝胆胰外科杂志2025，Vol.37Issue(5)：307-312,6.DOI:10.11952/j.issn.1007-1954.2025.05.004
肝门部胆管癌术后实现教科书式结局与总生存时间的关系
Relationship between achieving textbook outcomes in liver surgery and the overall survival for perihilar cholangiocarcinoma after major hepatectomy
张进 1庞书杰 2刘兴超 3樊海宁 4陈志宇 1张庆仪 1罗宇乐 1钟诗芸 1高书扬 1杨雪儿 1白洁 1江艳 1刘智鹏 1弓毅1
作者信息
- 1. 陆军军医大学第一附属医院肝胆外科 全军肝胆外科研究所,重庆 400038
- 2. 海军军医大学附属东方肝胆外科医院肝胆外科,上海 200433
- 3. 四川省人民医院肝胆外科,四川 成都 610072
- 4. 青海大学附属医院肝胆胰外科,青海 西宁 810012
- 折叠
摘要
Abstract
Objective Major hepatectomy is the primary curative technique for perihilar cholangiocarcinoma(pCCA).Textbook outcomes in liver surgery(TOLS)serve as comprehensive perioperative outcome metrics for liver surgery.This study aims to explore the relationship between achieving TOLS and the overall survival(OS)for pCCA after major hepatectomy.Methods This study consecutively enrolled patients with pCCA who underwent major hepatectomy in the First Affiliated Hospital of Army Medical University(n=159),Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University(n=113),Sichuan Provincial People's Hospital(n=40),and Qinghai University Affiliated Hospital(n=50)from Jan.2014 to Mar.2020.TOLS was defined as no intraoperative events≥grade 2,no postoperative grade B/C bile leakage,no postoperative grade B/C liver failure,no severe postoperative complication(Clavien-Dindo grade Ⅲ or Ⅳ),no re-hospitalization within 90 d due to major complications,no death within 90 d post-discharge,and negative margin.The Kaplan-Meier curves were drawn,and the overall survival(OS)difference between patients who achieved TOLS and those who did not achieve was compared.Cox regression model was employed to identify independent risk factors for OS.Results A total of 362 patients who underwent major hepatectomy for pCCA were included in this study,of whom 192(53.0%)achieved TOLS.The 5-year OS rate for those who achieved TOLS(n=192)was significantly higher than those who did not achieve(n=119)(39.7%vs 30.8%,P=0.005).Multivariate Cox regression analysis confirmed that,achieving TOLS was independently associated with better OS(HR 0.750,95%CI 0.553 to 0.912,P=0.042).Conclusion pCCA patients who achieve TOLS after major hepatectomy not only experience optimal perioperative outcomes but also obtain improved long-term survival.关键词
肝门部胆管癌/大范围肝切除术/肝脏手术教科书式结局/总生存期Key words
perihilar cholangiocarcinoma/major hepatectomy/textbook outcomes in liver surgery/overall survival分类
临床医学引用本文复制引用
张进,庞书杰,刘兴超,樊海宁,陈志宇,张庆仪,罗宇乐,钟诗芸,高书扬,杨雪儿,白洁,江艳,刘智鹏,弓毅..肝门部胆管癌术后实现教科书式结局与总生存时间的关系[J].肝胆胰外科杂志,2025,37(5):307-312,6.
