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Meta-Analysis
. 2013 Jul;15(7):492-503.
doi: 10.1111/j.1477-2574.2012.00616.x. Epub 2013 Jan 8.

Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma

Saleh Abbas  1 , Charbel Sandroussi
Affiliations
Meta-Analysis

Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma

Saleh Abbas et al. HPB (Oxford). 2013 Jul.

Abstract

Background: The management of hilar cholangiocarcinoma has evolved over time and extended liver resection, including the caudate lobe, and major vascular resection and extended lymphadenectomy have become established practice. The benefit of vascular resection has not been investigated.

Methods: A systematic search of the MEDLINE and EMBASE databases was used to identify studies. A systematic review and a meta-analysis of the available studies were conducted according to PRISMA guidelines. Odds ratios were calculated using the Mantel-Haenszel method. Primary outcome variables assessed included morbidity, mortality, vascular complications and the effect of vascular resection on longterm survival.

Results: Of 411 search results, only 24 studies reported the results of vascular resection in hilar cholangiocarcinoma. Meta-analysis showed increased morbidity and mortality with hepatic artery resection. Portal vein resection was achievable with no impact on postoperative mortality. Vascular resection did not improve negative margin rates and had no impact on longterm survival.

Conclusions: Portal vein resection does not preclude curative resection; however, it is not routinely recommended unless there is suspicion of tumour invasion. There was no proven survival advantage with portal vein resection. Arterial resection results in higher morbidity and mortality with no proven benefit.

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Figures

Figure 1
Figure 1
Flow chart showing the study selection process
Figure 2
Figure 2
Vascular complications in patients with and without vascular resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 3
Figure 3
Mortality rates in patients with and without vascular resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 4
Figure 4
Overall morbidity rates in patients with and without vascular resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 5
Figure 5
Mortality in patients with and without hepatic artery resection and reconstruction. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 6
Figure 6
Liver failure rates in patients with and without vascular resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 7
Figure 7
Five-year survival in patients with R0 resection (negative margins) and R1 resection (microscopically involved margins). M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 8
Figure 8
Five-year survival in patients with and without vascular resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 9
Figure 9
Rates of R0 resection in patients with and without vascular resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 10
Figure 10
Anastomotic leak from (hepaticojejunostomy) in patients with and without arterial resection. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
Figure 11
Figure 11
Effect of vascular wall invasion on 5-year survival. M–H, Mantel–Haenszel test; OR, odds ratio; 95% CI, 95% confidence interval
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