Effect Evaluation Of Combined Vascular Resection In Surgical Management Of Hilar Cholangiocarcinoma: A Meta-analysis

Objective: The vascular was frequently invaded in hilar cholangiocarcinoma(HCCA). However, the safety and effectiveness of combined vascular resection(VR) is controversial. The aim of this study was to evaluate the role of VR in surgical management of HCCA.Methods: A systematic search of Pub Med, the Cochrane Library, Embase, CNKI and Wan Fang etc. databases until November 2015 with the key words “hilar cholangiocarcinoma OR proximal bile duct cancer OR Klatskin tumour” AND ”vascular resection OR portal vein resection OR hepatic artery resection” was performed. Major outcome variables were assessed including safety indicators(morbidity and morbidity) and effective indicators(1-, 3-and 5-year overall survival). Subgroup analysis(portal vein resection subgroup and hepatic artery resection subgroup) was employed to explore the role of combined VR in different type of blood vessels. Odds ratios(OR) and 95% confidence interval(CI) were estimated.Results: Twenty seven studies with a total of 3218 HCCA patients were included, of whom 888 cases underwent combined VR treatment(VR combination group), and 2330 cases had no combined VR treatment(control group). Our overall group meta-analysis observed that patients who received combined VR correlated with worse safety indicators(mortality and morbidity)(OR=2.74, 95%CI: 1.72~4.37 and OR=2.48, 95% Cl: 1.44~4.28, both P<0.05) and poorer safety indicators(1-, 3- and 5-year overall survival)(1-year: OR=0.60, 95%CI: 0.49~0.73; 3-year: OR=0.57, 95%CI: 0.47~0.69; 5-year: OR=0.61, 95%CI: 0.41~0.91, all P<0.05) when compared with the non-VR patients. However, in the portal vein resection subgroup, although the morbidity was higher in portal vein resection group(OR=1.77, 95%CI: 1.29~2.43, P<0.05), no differences were noted between two groups in other effective and safety indicators(mortality: OR=1.54, 95%CI: 0.86～2.75; 1-year overall survival: OR=0.87, 95%CI: 0.51～1.46; 3-year overall survival: OR=0.89, 95%CI: 0.57～1.40; 5-year overall survival: OR=0.79, 95%CI: 0.60～1.05; all P>0.05). In the hepatic artery resection subgroup, all the pooled outcomes were consistent with overall group analysis. There were significant differences regarding all safety and effective indicators favoring control group than hepatic artery resection group(mortality: OR=12.76, 95%CI: 3.22～50.52; morbidity: OR=6.39, 95%CI: 3.45～11.82; 1-year overall survival: OR=0.45, 95%CI: 0.29～0.70; 3-year overall survival: OR=0.43, 95%CI: 0.25～0.75; 5-year overall survival: OR=0.24, 95%CI: 0.10～0.59; all P<0.05).Conclusions: Combined with VR was considered to be feasible for HCCA patients who were restricted to portal vein invasion. However, if hepatic artery was invaded, VR should be made cautiously, since hepatic artery resection could diminish the survival time and increase the mortality and morbidity.