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간절제를 병용실시한 Klatskin 담관암 50예의 단기치료성적
김명환,박광민,이성구,이승규,최건무,황신,조용필,이영주,민병철,성규보,우돈희,김우영,전훈배 대한소화기학회 1997 대한소화기학회지 Vol.30 No.3
Background/Aims: The fact that a positive correlation between the absence of residual tumors at resection margins and the long-term survival for treatment of hilar cholangiocarcinoma has encouraged some surgeons to perform a more radical approach, including liver/portal vein resection and combined pancreatoduodenectomy. However, if liver resection is associated with significant morbidity and mortality, it may not produce any overall benefit. This review was undertaken in an attempt of determine that liver resection is a safe procedure and has a more beneficial effect than local bile duct excision alone in terms of achieving curative resection and long-term survival. Methods: Sixty-nine patients with hilar cholangiocarcinoma surgically treated between lanuary 1990 and February 1996 at the Asan Medical Center were retrospectively analyzed. Local bile duct excision alone was performed in 10 patients. Liver resection for tumor extending to secondary bile ducts or hepatic parenchyma was performed in 50 patients. Among 50 liver resections, portal vein resection was necessary in 17 and pancreatoduodenectorny was combined in 9 patients. Results: Operative mortality occurred in 4 patients only after liver resection. Margins of bile duct resection were free from turnor on histologic examination in only 3 of 10 local excision, but in 41 of 50 liver resection. Cumulative survival rate after local excision was 85.7% at 1 year, 42.9% at 2 years, 21.4% at 3 years and 0% at 4 years. However, survival rate after liver resection excluding operative mortality was 92.2% at 1 year, 75.3% at 2 years, 50.2% at 3 years and 25.1% at 5 years. Conclusions: The survival and achieving rate of tumor-free resection margin after liver resection was superior to that after local excision. Resections of hilar cholangiocarcinoma offer long-term survival only when surgery is aggressive and includes liver resection.