Abstract: Objective:To systematically evaluate the safety and effectiveness of combined portal vein resection and reconstruction in the resection of hilar cholangiocarcinoma.
Methods:Literatures were researched using Cochrane Library, PubMed, Embase, China Biology Medicine disc, China National Knowledge Infrastructure,Wanfang database, VIP database from January 31, 2006 to January 31, 2016 with the key words including “hilar cholangiocarcinoma” “Klatskin tumor” “Bile duct neoplasm” “Vascular resection” “portal vein resection” “肝门部胆管癌” “血管切除” “门静脉切除”. The clinical studies of resection of hilar cholangiocarcinoma with portal vein resection and construction and without vascular resection and construction were received and enrolled. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Patients who underwent resection of hilar cholangiocarcinoma combined with portal vein resection and reconstruction were allocated into the portal vein resection group and patients who didn′t undergo vascular resection were allocated into the no vascular resection group. Analysis indicators included (1) results of literature retrieval; (2) results of Metaanalysis: ① incidence of postoperative complications (hepatic failure, biliary fistula, intraabdominal hemorrhage), ② postoperative mortality, ③ patients′ prognosis, ④ related indicators of postoperative pathology (lymph node metastasis rate, moderate and lowdifferentiated rate, nerve invasion rate, negative rate of resection margin). The heterogeneity of the studies was analyzed using the I2 test. The hazard ratio (HR) and 95% confidence interval (CI) were used for assessing the prognostic indicators. The incidence of complications, mortality and pathological indicators were evaluated by the odds ratio (OR) and 95%CI.
Results:(1) Results of literature retrieval: 13 retrospective studies were enrolled in the metaanalysis, and the total sample size was 1 668 cases including 437 in the portal vein resection group and 1 231 in the no vascular resection group. (2) Results of Metaanalysis: ① incidence of postoperative complications was respectively 39.86% in the portal vein resection group and 35.27% in the no vascular resection group, with no statistically significant difference between the 2 groups (OR=1.12, 95%CI: 0. 8²-1.53, P>0.05). The results of subgroup analysis showed that hepatic failure, biliary fistula and intraabdominal hemorrhage were postoperative main complications, and the incidences were 17.09%, 8.79%, 6.25% in the portal vein resection group and 10.62%, 9.69%, 2.51% in the no vascular resection group, respectively, with no statistically significant difference between the 2 groups (OR=0.48, 1.13, 0.82, 95%CI: 0.23-1.02, 0.45-2.83, 0.21-3.12, P>0.05). ② Postoperative mortality was respectively 5.38% in the portal vein resection group and 3.88% in the no vascular resection group, with no statistically significant difference between the 2 groups (OR=1.16, 95%CI: 0.6²-2.14, P>0.05). ③ There was statistically significant difference in patients′ prognosis between the 2 groups (HR=1.81, 95%CI: 1.5²-2.16, P<0.05). ④ The related indicators of postoperative pathology: lymph node metastasis rate, moderate and lowdifferentiated rate and negative rate of resection margin were 41.55%, 76.42%, 63.74% in the portal vein resection group and 33.42%, 66.75%, 64.29% in the no vascular resection group, respectively, with no statistically significant difference between the 2 groups (OR=1.45, 1.59, 0.67, 95%CI: 0.95-2.21, 0.97-2.61, 0.37-1.20, P>0.05).The nerve invasion rate was 83.47% in the portal vein resection group and 64.90% in the no vascular resection group, with a statistically significant difference between the 2 groups (OR=2.61, 95%CI: 1.45- 4.70, P<0.05).
Conclusion: Combined portal vein resection and reconstruction is safe and feasible in the treatment of hilar cholangiocarcinoma, and the prognosis of patients with portal vein invasion is worse than that without portal vein invasion.