The Value Of Partial Hepatectomy And Caudate Lobectomy In Hilar Cholangiocarcinoma Treatment-Meta Analysis

Objective To discuss the value of partial hepatectomy and caudate lobectomy besides choledochotomy to patients with hilar cholangiocarcinoma.Methods English literatures related to hilar cholangiocarcinoma from January 1, 1990 to December 31,2013 were searched in PubMed database, and postoperative radical cure information, survival condition, morbidity and mortality after operation of the patients were extracted from papers that are satisfied the inclusion criteria for Meta analysis.Results 26 papers satisfied the inclusion criteria belonged to 8 study groups. After combining the papers in hepatectomy radical cure group(18 papers), hepatectomy survival group(14 papers), hepatectomy morbidity group(8 papers) and hepatectomy mortality group(16 papers), we found that the rate of radical cure after partial hepatectomy (OR 2.99,95%CI 1.88-4.77) and the survival condition(HR 0.69,95%CI 0.58-0.82) were obviously higher than choledochotomy group, while morbidity (OR 2.05,95%CI 1.38-3.05) and mortality(OR 2.76,95%CI 1.47-5.15) of the patients in partial hepatectomy group was higher than choledochotomy group. Since there’s significant heterogeneity among papers in hepatectomy radical cure group (I2=69.3%, p=0.000), sub-group analysis was conducted and the result revealed if the branches of secondary bile ducts wasn’t involved by hilar cholangiocarcinoma, simple choledochotomy could have the same radical cure effect as combined with partial hepatectomy(OR 1.06,95%CI 0.61-1.85). After combining the papers in caudate lobectomy radical cure group(5 papers), caudate lobectomy survival group(8 papers), caudate lobectomy morbidity group(3 papers) and caudate lobectomy mortality group(3 papers) respectively, OR values indicated that the rate of radical cure(OR 4.57,95%CI 2.45-8.48) and the survival condition (HR 0.44,95%CI 0.36-0.54) of combined caudate lobectomy group were better than those patients whose caudate lobe were perserved, and the morbidity (OR 1.11,95%CI 0.69-1.79) and mortality(OR 1.40,95%CI 0.51-3.88) were not obviously higher.Conclusions Partial hepatectomy can increase the radical cure opportunity for patients with hilar cholangiocarcinoma, and extend the survival time after operation, but the morbidity and mortality after operation are higher than choledochotomy. Choledochotomy still has its value for hilar cholangiocarcinoma Bismuth-Corlette Type Ⅰ and Ⅱ. Combing with caudate lobectomy can significantly increase the radical cure rate of hilar cholangiocarcinoma and postoperative survival time, and the morbidity and mortality after operation are not increased. Thus, caudate lobectomy can be included when conducting partial hepatectomy for hilar cholangiocarcinoma.