Dış safra yolu tümörlerinde sağkalımı etkileyen faktörler
Küçük Resim Yok
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kolanjiokarsinomlar safra yolu epitel dokusundan köken alan , genellikle ileri evrede tanı konulmakta ve bu nedenle de kötü sağkalıma sahip olan malign tümörlerdir.Literatürde safra yolu tümörlerinde sağkalıma etki eden birçok faktörler araştırılmış ve tartışma yarata bilecek sonuçlar alınmıştır.Bu çalışmada Ege Üniversitesi Tıp Fakültesi Genel Cerrahi kliniğine 2001-2010 yılları arasında dış safra yolu tümörü tanısıyla tedavi gören toplam 77 olgu retrospektiv olarak incelenmiştir.Olguların yaş ortalaması 60,3+_10,8 yıl(32-80 yıl) olup 33 (%42,9) erkek 44(%57,1) kadın ve kadın erkek oranı 0,75 idi. DSY tümörü ön tanısı ile başvuran olguların 32'si (%41,6) safra kesesi tümörü , 39'u(%50,6) hiler kolanjiokarsinom(Klatskin),6'sı(%7,8) distal koledok tümörü idi.Dopller USG, BT ve MRCP nin bu tümörlerde yüksek tanıkondurucu özelliğie sahip idi.Biz bu çalışmada radikal ve sınırlı cerrahinin, cerrahi sınır pozitifliğinin, preoperativ değerlendirmede yükselen bilirubin, CA19-9 değerlerinin ,uygulanan stent tipinin, kemoterapi ve radyoterapinin dıs fara yolu tümörlerinde sağkalım üzerinde olan etkisini araştırdık.Yüksek bilirubin düzeyleri 3 ve CA19-9 düzeyleri ise 4 grupta irdelendi.Sonuç olarak : Kemoterapi, radyoterapi,stent tipi, bilirubin düzeyinin,radikal ve sınırlı cerrahinin sağkalım üzerinde istatiksel olarak anlamlı bir etkisinin olmadığı görüldü. Yüksek CA19-9 düzeyleri sağkalım üzerine etkisi olan prognostik bir faktördür.(p=0,033 ). Bunun yanı sıra, tümör yerinde bırakılan hastalar ile, cerrahi sınır negatif olacak şekilde rezeksiyon uygulanan (lobektomili veya lobektomisiz) hastalar ile karşılaştırıldığında, sağkalım istatiksel olarak anlamlı idi (p=0,003)
Cholangiocarcinomas are malignant epithelial tumors of biliary tract that have poor prognosis due to frequent delay in their diagnosis. There are many studies in the literature regarding the prognostic factors effecting mortality of cholangiocarcinoma but yet there is still debate about these factors. Hereby in this study we retrospectively analyzed 77 patients who were treated owing to tumors of extra hepatic biliary tree in Ege University Faculty of Medicine department of General Surgery between 2001 and 2010.Mean age of the patients was 60,3 ± 10,8 years. Thirty-three of the patients (42,9%) were male and 44 of them were female (57,1%). Male / female ratio of the patients was 0,75. Anatomic distribution of the tumors was as follows: 32 of the patients (41,6%) had their tumor on the gallbladder, 39 of them (50,6%) had hilar cholangiocarcinoma (Klatskin?s tumor) and the remaining 6 (7,8%) had distal choledoc tumors. Ultrasonography (USG), computerized tomography (CT) and magnetic resonance cholangio pancreaticography (MRCP) were frequently utilized for diagnosing the patients and evaluating the tumors. In this study we analyzed the prognostic value of radical or marginal surgery, preoperative bilirubin and CA 19-9 values, stent type, chemotherapy and/or radiotherapy on extra hepatic biliary tree tumors. The patients were categorized into 3 groups regarding to their bilirubin values and 4 groups regarding to their CA 19 ? 9 values.Results: Chemotherapy, radiotherapy, stent type, preoperative bilirubin value and radical surgery proved no effect on mortality, however high levels of CA 19 ? 9 (p=0,033) had a statistically significant effect on survival. Nevertheless, survival showed significance in patients undergoing marginal surgery (with or without lobectomy) with negative surgical margins (p=0,003), when compared with patients where the tumor has been left inside.
Cholangiocarcinomas are malignant epithelial tumors of biliary tract that have poor prognosis due to frequent delay in their diagnosis. There are many studies in the literature regarding the prognostic factors effecting mortality of cholangiocarcinoma but yet there is still debate about these factors. Hereby in this study we retrospectively analyzed 77 patients who were treated owing to tumors of extra hepatic biliary tree in Ege University Faculty of Medicine department of General Surgery between 2001 and 2010.Mean age of the patients was 60,3 ± 10,8 years. Thirty-three of the patients (42,9%) were male and 44 of them were female (57,1%). Male / female ratio of the patients was 0,75. Anatomic distribution of the tumors was as follows: 32 of the patients (41,6%) had their tumor on the gallbladder, 39 of them (50,6%) had hilar cholangiocarcinoma (Klatskin?s tumor) and the remaining 6 (7,8%) had distal choledoc tumors. Ultrasonography (USG), computerized tomography (CT) and magnetic resonance cholangio pancreaticography (MRCP) were frequently utilized for diagnosing the patients and evaluating the tumors. In this study we analyzed the prognostic value of radical or marginal surgery, preoperative bilirubin and CA 19-9 values, stent type, chemotherapy and/or radiotherapy on extra hepatic biliary tree tumors. The patients were categorized into 3 groups regarding to their bilirubin values and 4 groups regarding to their CA 19 ? 9 values.Results: Chemotherapy, radiotherapy, stent type, preoperative bilirubin value and radical surgery proved no effect on mortality, however high levels of CA 19 ? 9 (p=0,033) had a statistically significant effect on survival. Nevertheless, survival showed significance in patients undergoing marginal surgery (with or without lobectomy) with negative surgical margins (p=0,003), when compared with patients where the tumor has been left inside.
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery, Cerrahi, Surgery, Karsinoma, Carcinoma, Kolestaz, Cholestasis, Neoplazmlar, Neoplasms, Prognoz, Prognosis, Safra kanal neoplazmları, Bile duct neoplasms, Safra kanalları, Bile ducts, Sağkalım, Survival
