| Objective To evaluate the safety and efficacy of preoperative pretreatment for perihilar cholangiocarcinoma,to compare the effects of surgery after preoperative pretreatment and direct surgery without pretreatment,and to analyze the prognosis of patients and their influencing factors.Methods A multicenter retrospective cohort study was conducted.The clinical data of 155 patients who were admitted to Affiliated Hospital of Nantong University,Affiliated Hospital of North Sichuan Medical College and Chaohu Hospital of Anhui Medical University from January 2015 to August 2020 were collected;131patients were enrolled,including 75 males and 56 females,aged from 29 to 81 years,with a median age of 64 years.All the 131 patients underwent open surgery,and postoperative pathological examination confirmed p CCA.Among them,92 patients underwent pretreatment before surgery and were set as the pretreatment group.Thirty-nine cases did not undergo pretreatment before operation,and were set as the non-pretreatment group.The preoperative situation,intraoperative situation,postoperative pathology,postoperative complications,postoperative recovery and postoperative survival were recorded and analyzed,and prognostic factors were also analyzed.Follow-up visits were conducted in an outpatient clinics or by telephone.The deadline for follow-up was August 31,2021.Measurement data with skewed distribution were represented as median(range),and the t-test or Wilcoxon signed rank-sum test was used for comparison between groups.Count data were compared between groups using the chi-square test.Survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method,and the log-rank test was used for survival analysis.Univariate and multivariate analyses were performed using the COX proportional hazards model.Results(1)Preoperative conditions after pretreatment: TBil in the pretreatment group decreased from 132.8(87.4～416.4)μmol/L to 40.9(7.6～83.3)μmol/L,and ALT decreased from 126.3(10.0～761.9)U/L to 52.6(9.4～227.2)U/L.The reserved liver volume/whole liver volume increased from 33.1(16.2～45.5)% before PVE to 42.9(28.8～63.6)%;the ICG K value of reserved liver was 0.065(0.050～0.121);The regeneration rate was 11.0(3.1 ～ 35.4)%.There were changes in biochemical indexes of patients after pretreatment,and there were differences in preoperative comparison.(2)Intraoperative and postoperative conditions: There were statistically significant differences in intraoperative blood loss,R0 resection,and ALT one week after operation.There was a statistically significant difference in the incidence of postoperative serious complications and even death between the two groups.Mortality within 1 month postoperatively was2.2% and 7.7% in the pretreated and untreated groups,respectively.(3)Survival status after surgery: 131 patients were followed up after operation,and the follow-up time was 1～68.5 months,and the median follow-up time was 19.9 months.During the follow-up period of 131 patients,78 died,including 49(53.3%)in the pretreatment group and 29(74.4%)in the unpretreated group;57 patients had tumor recurrence,including 35(38.0%)in the pretreatment group and 22(56.4%)in the unpretreated group.The 1-,2-,and 3-year overall survival rates of the pretreated and untreated patients were 80.4%,43.5%,18.5%,and 69.2%,25.6%,and 10.3%,respectively.The 1-,2-,and 3-year disease-free survival rates were were 68.5%,30.4%,12.0% and 59.0%,17.9%,7.7%.There was a statistically significant difference in the overall survival rate between the two groups(P=0.034),and a statistically significant difference in the tumor-free survival rate(P=0.005).(4)Analysis of prognostic factors: preoperative pretreatment,surgical margins,and tumor differentiation were independent risk factors for overall survival after surgery for perihilar cholangiocarcinoma;preoperative pretreatment,surgical margins,vascular tumor thrombus,and tumor differentiation were independent risk factors for recurrence-free survival after surgery for perihilar cholangiocarcinoma.Conclusion Preoperative pretreatment can effectively restore the liver function of patients,reduce the occurrence of postoperative complications,improve the prognosis of patients with perihilar cholangiocarcinoma,and enable more patients to obtain the opportunity of radical surgery.The patients who underwent preoperative pretreatment,achieved R0 resection after surgery and the higher the degree of tumor differentiation had better postoperative overall survival;the patients who underwent preoperative pretreatment,achieved R0 resection after surgery,the higher the degree of tumor differentiation,and no intravascular tumor thrombus had better postoperative recurrence-free survival.For suitable patients with perihilar cholangiocarcinoma,preoperative pretreatment should be actively performed. |
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