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

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.

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

“…Thus, Chen and co-workers (32) and Bai and coworkers (31) identify significantly lower negative resection margin rates in the PVR group, while Wu and co-workers and Abbas and coworkers showed no significant differences (30,33).…”

“…Furthermore, no differences between the groups were observed for the perineural invasion and metastatic lymph nodes rates (Table 2). Significantly increased perineural invasion and metastatic lymph nodes rates were found for the PVR group in three metaanalyses, compared with the patients without a PVR (31)(32)(33).…”

“…Only one study showed significantly increased morbidity rates when a PVR is performed (23). Recent meta-analyses of comparative studies of combined PVR for PHC have shown no significantly increased morbidity rates for the PVR group (29)(30)(31)(32)(33). Significantly increased mortality rates were reported for the PVR group in four meta-analyses (29)(30)(31)33), while one meta-analysis did not identify any differences (32).…”

“…Four meta-analyses have shown conflicting results regarding the impact of a PVR on the negative resection margin rates (30)(31)(32)(33). Thus, Chen and co-workers (32) and Bai and coworkers (31) identify significantly lower negative resection margin rates in the PVR group, while Wu and co-workers and Abbas and coworkers showed no significant differences (30,33).…”

“…However, the impact of a PVR in PHC surgery remains controversial and previous comparative studies reached conflicting results (5,7,11,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), none including patients from Eastern Europe. Furthermore, meta-analyses comparing the outcomes of patients with and without a PVR for PHC did not reach the same conclusions (29)(30)(31)(32)(33).…”