Analysis Of The Therapeutic Effect Of Combined Hepatic Artery Resection In The Treatment Of Hilar Cholangiocarcinoma

Background and Objectives:Hilar cholangiocarcinoma(HCCA)originates from the cells of the hilar bile duct mucosa.It is a highly malignant tumor with a poor clinical prognosis.At present,surgical resection is still the best treatment method.However,due to its invasive growth characteristics,the later stage tumor is likely to invade the hepatic artery,and due to the importance of the hepatic artery to the liver’s blood supply and the difficulty of arterial anastomosis,there is no clinical consensus on whether hepatic artery resection is feasible.This study intends to analyze patient data of Zhengzhou University People’s Hospital,and use the method of Meta-analysis to evaluate the safety and efficacy of combined hepatic artery resection during the surgical treatment of hilar cholangiocarcinoma.Methods:1.The data of hilar cholangiocarcinoma patients who were hospitalized in the People’s Hospital of Zhengzhou University from January 2014 to December 2018 were retrospectively collected and grouped.Statistical analysis was performed using SPSS 25.0 software.The measurement data is tested for normal distribution.The measurement data conforming to the normal distribution are expressed by the mean ±standard deviation(（？）±s)and the independent sample t test is used.The median(M)and the quartile are used for the skewed distribution data.Number spacing(P25,P75)is expressed and the rank sum test is used.The count data is expressed by the rate or composition ratio using the continuously adjusted χ2 test.Kaplan-Meier method was used for survival analysis and log-rank test was used.Inspection level P=0.05.2.Search Pubmed,Embase,Web of Science,The Cochrane Library and Chinese databases in English databases,China Biomedical Literature Database(CBM),Wanfang Data Resource System,China Knowledge Network(CNKI),VIP-Chinese Science and Technology Journal System Database(VIP)database.Collect the related randomized controlled studies or retrospective studies on the safety and efficacy analysis of combined hepatic artery resection and non-combined hepatic artery resection during radical resection of hilar cholangiocarcinoma.The database search time is set from January 1,2006 to December 31,2019.The Review Manager 5.3software is used to summarize and analyze the data in all the documents and the results are presented in the form of forest diagrams.At the same time,Stata14.0software is used to analyze the publication deviation of the literature and draw a funnel diagram.Results:1.A total of 63 patients were collected,of which 7 cases were combined with hepatic artery resection(HAR group)and 56 cases were not combined with hepatic artery resection(control group).The perioperative mortality rate in the HAR group was 14.2%,and the perioperative mortality rate in the control group was 3.6%.There was no significant difference between the two groups(P=0.754).The postoperative complication rate in the HAR group was 85.7%,and the postoperative complication rate in the control group was 51.8%.There was no significant difference between the two groups(P=0.194).The 1-,3-,and 5-year survival rates of the HAR group were42.9%,28.6% and 0.The 1-,3-,and 5-year survival rates of the control group were53.6%,33.9%,and 27.8%.The log-rank test results showed that there was a difference between the two groups.The difference was not significant(P=0.586).2.A total of 2374 patients with hilar cholangiocarcinoma were included in the study,including 351 patients with combined hepatic artery resection(HAR group)and 2023 patients without combined hepatic artery resection(control group).Analysis results showed that the perioperative mortality in the HAR group was higher than that of the control group(OR=1.70,95%CI=0.02 ～ 2.90,P=0.05),and the total postoperative morbidity rate was higher than that of the control group(OR=1.28,95%CI= 0.93～1.76,P=0.13),both of which were not statistically significant compared with the control group.Subgroup analysis showed that the incidence of liver failure(OR=1.15,95%CI= 0.73～1.82,P=0.54),biliary fistula(OR=1.20,95%CI= 0.78～1.84,P=0.40),and abdominal infection in the two groups(OR= 0.98,95% CI= 0.53～1.83,P=0.95)There was no significant difference.The R0 resection rate of the HAR group was higher than that of the control group,and the difference was not statistically significant(OR=1.08,95%CI=0.66～1.75,P=0.77).The rate of lymph node metastasis in the HAR group was higher(OR= 2.48,95% CI= 1.05～5.84,P=0.04),1(OR=0.48,95%CI= 0.32 ～ 0.72,P=0.0005),3(OR=0.51,95%CI=0.36～0.72,P=0.0001),5(OR=0.50,95%CI=0.35～0.70,P<0.0001)annual survival rates were lower than the control group.The survival rates of patients in HAR group treated with combined chemotherapy drugs after operation were significantly improved(OR= 7.33,P=0.02).Conclusion:1.The safety of combined HAR in the treatment of hilar cholangiocarcinoma is acceptable,but survival has not been significantly improved after surgery,which may be related to the high lymph node metastasis rate in patients with hilar cholangiocarcinoma combined with HAR.Therefore,it is still necessary to be cautious in carrying out this operation;2.If hilar cholangiocarcinoma is combined with adjuvant chemotherapy after surgery,it may improve survival.