Journal of Gastrointestinal Surgery

, Volume 17, Issue 6, pp 1107–1115

Combined Portal Vein Resection for Hilar Cholangiocarcinoma: A Meta-analysis of Comparative Studies

  • Xiang-Song Wu
  • Ping Dong
  • Jun Gu
  • Mao-Lan Li
  • Wen-Guang Wu
  • Jian-Hua Lu
  • Jia-Sheng Mu
  • Qi-Chen Ding
  • Lin Zhang
  • Qian Ding
  • Hao Weng
  • Ying-Bin Liu
Original Article

DOI: 10.1007/s11605-013-2202-9

Cite this article as:
Wu, X., Dong, P., Gu, J. et al. J Gastrointest Surg (2013) 17: 1107. doi:10.1007/s11605-013-2202-9

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.

Keywords

Hilar cholangiocarcinomaKlatskin tumorPortal vein resectionSurgeryMeta-analysis

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Xiang-Song Wu
    • 1
  • Ping Dong
    • 1
  • Jun Gu
    • 1
  • Mao-Lan Li
    • 1
  • Wen-Guang Wu
    • 1
  • Jian-Hua Lu
    • 1
  • Jia-Sheng Mu
    • 1
  • Qi-Chen Ding
    • 1
  • Lin Zhang
    • 1
  • Qian Ding
    • 1
  • Hao Weng
    • 1
  • Ying-Bin Liu
    • 1
  1. 1.Department of General Surgery, Xinhua HospitalShanghai JiaoTong University School of MedicineShanghaiChina