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Combined portal vein resection for hilar cholangiocarcinoma
Tao Bai1, Jie Chen1, Zhi-Bo Xie1
1Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, P. R. China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, P. R. China.
Insights
Combined portal vein resection (PVR) for hilar cholangiocarcinoma (HCCA) does not increase morbidity. However, PVR is associated with higher mortality and worse survival rates in advanced HCCA cases.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hilar cholangiocarcinoma (HCCA) is a challenging malignancy requiring surgical intervention.
- Complete resection is crucial for curative treatment of HCCA.
- Combined portal vein resection (PVR) is considered for HCCA with portal vein invasion to achieve negative margins.
Purpose of the Study:
- To systematically review and analyze the efficacy of combined PVR in HCCA patients.
- To evaluate the impact of PVR on resection margins, morbidity, and survival in HCCA.
Main Methods:
- A systematic review of studies published up to April 2015.
- Inclusion of data from MEDLINE, EMBASE, Cochrane Library, CNKI, and clinical trial registries.
- Calculation of risk ratios (RRs) and 95% confidence intervals (CIs) for outcomes.
Main Results:
- Analysis of 21 retrospective studies with 2403 patients (637 with PVR, 1766 without).
- Patients undergoing PVR had more advanced HCCA (lymphatic and perineural invasion) and fewer curative resections.
- Postoperative morbidity was similar, but PVR was associated with higher mortality and worse 5-year survival rates.
Conclusions:
- Combined PVR for HCCA does not increase postoperative morbidity.
- Increased mortality and worse survival in the PVR group are linked to more advanced disease.
- Further high-quality trials are needed to validate these findings.
Background:
Surgery is the only curative therapy for patients with hilar cholangiocarcinoma (HCCA). Combined portal vein resection (PVR) could achieve negative resection margins in HCCA patients with portal vein invasion. This systematic review aimed to analysis the efficiency of combined PVR for HCCA.
Methods:
MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database, and clinical trial registries were searched through April 2015. Risk ratios (RRs), and 95% confidence intervals (CIs) were calculated.
Results:
The analysis included 21 retrospective studies, altogether involving 2403 patients (patients with PVR, n=637; patients without PVR, n=1766). Patients with PVR were likely to have more advanced HCCA (lymphatic invasion: RR=1.14, 95% CI 1.02 to 1.28; perineural invasion: RR=1.31, 95% CI 1.05 to 1.63) and suffered less curative resections (RR=0.89, 95% CI 0.75 to 0.99). Postoperative morbidity was similar between patients with or without PVR (RR=1.06, 95% CI 0.94 to 1.02). Patients with PVR suffered higher mortality rate (RR=1.52, 95% CI 1.06 to 2.18), and worse 5-year survival rate (RR=0.67, 95% CI 0.49 to 0.91).
Conclusion:
Combined PVR for HCCA patients would not increase postoperative morbidity rate. However, ascribed to PVR group concluded more advanced HCCA patients; patients with PVR had increased postoperative mortality rate and worse survival rate. The results still need further high quality trails for validation.
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