Gaziantep yöresindeki kolanjiokarsinom olgularının demografik ve klinik özellikleri

Abstract

Bu çalışmada son 5 yıl içinde Gaziantep Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniğinde kolanjiokarsinom tanısı alan hastaların demografik özellikleri, klinik seyirleri ve surveyleri ortaya koymak amacıyla kayıtları retrospektif olarak incelendi. Bu süre zarfında kliniğimizde kolanjiokarsinom tanısı alan 52 hastanın kayıtlarına ulaşılabildı.Hastaların 27'sı erkek (%51.9), 25'i bayandı (%48.07) ve kadın/erkek oranı 0.92 idi. Yaş ortalaması toplam 65.79+12.77 olup erkeklerde 62.18+13.55 kadınlarda ise 69.57+10.97 bulundu. En sık görülen semptom (%86.5) sarılık, ikinci sıklıkta kaşıntı (%30.7) idi.Modifiye Bismuth Corlette sınıflamasına göre 11 olgu Tip 1, 15 olgu Tip 2, 6 olgu Tip 3a, 14 olgu Tip 3b, 6 olgu Tip 4 olarak sınıflandırıldı. Burke T evreleme sistemine göre 27 olgu T1, 8 olgu T2, 17 olgu T3 olarak sınıflandırıldı.22 hastaya cerrahi işlem yapıldı. Yalnızca safra yolu rezeksiyonu 8 olguya, karaciğer rezeksiyonu ile birlikte safra yolu rezeksiyonu 14 olguya uygulandı. Karaciğer ve safra yolu rezeksiyonu ile birlikte; ek olarak pankreatikoduodenektomi 1, antrektomi 1, kaudat lobektomi 5 olguya uygulandı.Histopatolojik grade değerlendirmede; 7 olgu grade 1, 10 olgu grade 2, 5 olgu grade 3 olarak değerlendirildi. Tümörün safra yolu serozasına infiltrasyonu 20 olguda (pT2), lenf nodu metastazı (N1) 18 olguda, perinöral invazyon 12 olguda, vasküler invazyon 7 olguda, lenfatik invazyon 3 olguda, karaciğer invazyonu 10 olguda, antrum invazyonu 1 olguda, pankreas invazyonu 1 olguda görüldü.TNM evreleme sistemine göre Evre 1a (7 olgu), Evre 1b (11 olgu), Evre 2a (12 olgu), Evre 2b (9 olgu), Evre 3 (3 olgu) ve Evre 4 (10 olgu) olarak evrelendirildi. Morbidite ve mortalite oranları %77 ve %57 idi.Tüm olgularda ortalama yaşam süresi 9 ay olarak hesaplandı. Karaciğer rezeksiyonu uygulanan olgularda ortalama yaşam süresi 16 ay idi ve safra yolu rezeksiyonu uygulananlardan (ortalama yaşam süresi 8 ay) daha uzundu. Yaşam süresi üzerine etkili faktörlerin analizinde rezeksiyon tipi, negatif sınırlı cerrahi rezeksiyon ve perinöral invazyon istatiksel olarak anlamlı bulundu (p<0.05).Sonuç olarak; yöremizdeki KKA olgularının ileri yaşlarda ortaya çıktığı, cinsiyet farkının olmadığı ve tanı konulduğunda çoğunluğunun inoperabl olup sarılığın ana şikayet olduğu, sağkalım üzerine en etkili yöntemin cerrahi rezeksiyon tedavisi olduğu saptandı.Anahtar Kelimeler: Kolanjiokarsinom, Prognostik faktörler

In this study the records of the patients diagnosed with cholangiocarcinoma at Gaziantep University, Faculty of Medicine, Gastroenterology Clinic in last 5 years were retrospectively analysed to display the demographic characteristics, clinical progress and surveys of the patients. During this time out of all patients diagnosed with cholangiocarcinoma in our clinic we could reach the records of 52 patients.27(51.9%) of the patients were male and 25(48.07%) of them were female and male/female rate was 0.92. Total average age is 65.79+12.77 and this was 62.18+13.55 in men and 69.57+10.97 in women. The most common symptom was jaundice(86.5%) and the second one was pruritus(30.7%).According to modified Bismuth Corlette classification the cases was categorized as, 11 cases type 1, 15 cases type 2, 6 cases type 3a, 14 cases type 3b, 6 cases type 4. According to Burke T staging system the cases were categorized as: 27 cases T1, 8 cases T2, 17 cases T3.Surgical operation was applied to 22 patients. Only bile duct resection was applied to 8 cases, bile duct resection with liver resection was applied to 14 cases. With liver and bile duct resection by way of addition pancreaticoduodenectomy was applied to 1 case, antrectomy was applied to 1 case and caudat lobectomy was applied to 5 cases.In histopathologic grade assessment 7 cases were rated as grade 1, 10 cases were rated grade 2 and 5 cases were rated as grade 3. Infiltration of tumour to bile duct serous was observed in 20 cases (pT2), lymph node metastasis (N1) was observed in 18 cases, perineural metastasis was observed in 12 cases, vascular metastasis was observed in 7 cases, lymphatic metastasis was observed in 3 cases, liver metastasis was observed in 10 cases, antrum metastasis was observed in 1 case and pancreas metastasis was obserbed in 1 case.According to TNM staging system 7 cases were rated as phase 1a, 11 case as phase 1b, 12 cases as phase 2a, 9 cases as phase 2b, 3 cases as phase 3, and 10 cases as phase 4. Morbidity and mortality rates were 77% and 57%.In all cases, average life span was calculated as 9 months. In patients who were treated with liver resection the average life span was 16 months and their life span was longer than the patients who were treated with bile duct resection (the average life span was 8 months). In the analysis of factors affecting the life span resection type, negative limited surgical resection and perineural metastasis were significant statistically (p>0.05).In conclusion, it is confirmed that in our district CCA cases are seen at advanged age, there?s no difference in sexes, and when the patients are diagnosed most of them are inoperable, the main complaint is jaundice and the most efficient method on survival is surgical resection treatment.Key words: Cholangiocarcinoma, Prognostic Factors