Combined portal vein resection for hilar cholangiocarcinoma: a meta-analysis of comparative studies.
J Gastrointest Surg
; 17(6): 1107-15, 2013 Jun.
Article
in En
| MEDLINE
| ID: mdl-23592188
ABSTRACT
Hilar cholangiocarcinoma (HCCA) frequently invades into the adjacent portal vein, and portal vein resection (PVR) is the only way to manage this condition and achieve negative resection margins. However, the safety and effectiveness of PVR is controversial. Studies analyzing the effect of PVR on the surgical and pathological outcomes in the management of HCCA with gross portal vein involvement were considered eligible for this meta-analysis. The outcome variables analyzed included postoperative morbidity, mortality, survival rate, proportion of R0 resection, lymph node metastasis, microscopic vascular invasion, and perineural invasion. From 11 studies, 371 patients who received PVR and 1,029 who did not were identified and analyzed. Data from patients who received combined PVR correlated with higher postoperative death rates (OR = 2.31; 95 % CI, 1.21-4.43; P = 0.01) and more advanced tumor stage. No significant difference was detected in terms of morbidity, proportion of R0 resection, or 5-year survival rate. Subgroup analysis demonstrated that in centers with more experience or studies published after 2007, combined PVR did not cause significantly higher postoperative death. No strong evidence could suggest that combined PVR leads to more morbidity or mortality for patients with HCCA when the portal vein is grossly involved. In addition, combined PVR is oncologically valuable because R0 resection and 5-year survival did not differ significantly between two cohorts, despite the fact that the PVR cohort consisted of patients with more advanced HCCA.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Portal Vein
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Postoperative Complications
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Bile Duct Neoplasms
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Klatskin Tumor
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Cholangiocarcinoma
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Hepatic Duct, Common
Type of study:
Prognostic_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
J Gastrointest Surg
Journal subject:
GASTROENTEROLOGIA
Year:
2013
Document type:
Article
Affiliation country:
Publication country:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
/
UNITED STATES
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UNITED STATES OF AMERICA
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US
/
USA