Comparison Of Curative Effect Between Surgical Resection And Nonsurgical Treatment Of Advanced Intrahepatic Cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma is a malignant tumor of any part of the intrahepatic bile duct and its branches to the interlobular fine bile duct tree.The prognosis of intrahepatic cholangiocarcinoma is poor,and surgical resection is the only way to make patients get long-term survival.Advanced intrahepatic cholangiocarcinoma is an intrahepatic cholangiocarcinoma accompanied by intrahepatic metastasis and(or)vascular invasion and / or regional lymph node metastasis.It is still controversial whether surgical resection of advanced intrahepatic cholangiocarcinoma should be performed.European and American scholars believe that the disease has progressed to a relatively late stage,surgical resection is of limited significance for improving prognosis.Therefore,systemic chemotherapy is recommended first.The surgeons in the eastern countries such as China and Japan still strive for radical surgical resection for the patients.What is the better effect of surgical resection and nonsurgical treatment on improving the prognosis of patients with advanced intrahepatic cholangiocarcinoma? Further research is needed.ObjectiveTo compare the difference of curative effect between surgical resection and nonsurgical treatment of advanced intrahepatic cholangiocarcinoma patients,and provide evidence-based evidence for the clinical treatment decision of advanced intrahepatic cholangiocarcinoma patients.MethodA retrospective cohort study was used.According to the inclusion and exclusion criteria,122 cases of advanced intrahepatic cholangiocarcinoma patiens were collected from Hunan People's Hospital,Hepatobiliary Hospital and oncology department from January 1,2012 to October 1,2017.A total of 87 patients undergoing radical resection were included in the surgical resection group.35 patients who received radiotherapy and / or chemotherapy and/or biotargeted therapy were included in the nonsurgical group.The patients in the surgical group were diagnosed by pathological examination after operation.patients in the nonsurgical group were diagnosed by percutaneous liver biopsy.The general data were compared between the two groups,such as age,sex,ALT value,AST value,CA19-9 value,liver function Child classification,AJCC stage,tumor number,blood vessel(hepatic artery,portal vein)invasion rate,regional lymph node metastasis rate and so on.The data of surgical resection group were collected,such as hepatectomy and postoperative complications.The overall survival time of the two groups was compared.ResultThere was no significant difference in age,sex,ALT value,AST value,CA19-9 value,Child grade of liver function,AJCC stage,number of tumor,blood vessel(hepatic artery,portal vein)invasion and regional lymph node metastasis between the two groups(P > 0.05).The operative procedures were as follows: enlarged hemi hepatectomy in 31 cases(35.6%),left hemi hepatectomy in 27 cases(31%),right hemi hepatectomy in 22 cases(25.3%),and single lobe resection in 7 cases(8.1%).The total incidence of postoperative complications in the surgical group was about 26.3%,and there were no patients who died of perioperative complications.Survival time of patients with surgery group was significantly higher than that in non operative group(P < 0.05),the median survival time was 32 months and 15 months;1 year survival rates were 74.8%,58.7%;3 year survival rates were 42.4%,6.5%;5 year survival rates were 12.3%,0%.Conclusion1.Surgical treatment for patients with advanced intrahepatic cholangiocarcinoma does not significantly increase the incidence of postoperative complications.2.Operation may lead to a longer median survival time for patients with advanced intrahepatic cholangiocarcinoma,and a higher 1,3,and 5 year survival rate.