Clinical efficacy of combined portal vein resection and construction in the treatment of hilar cholangiocarcinoma: A Meta-analysis

Abstract

Objective To systematically evaluate the safety and effectiveness of combined vein and reconstruction in the of 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 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 of cholangiocarcinoma with vein and construction and without vascular and construction were received and enrolled. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Patients who underwent of cholangiocarcinoma combined with vein and reconstruction were allocated into the vein group and patients who didn′t undergo vascular were allocated into the no vascular group. Analysis indicators included (1) results of literature retrieval; (2) results of Meta-analysis: ① incidence of postoperative complications (hepatic failure, biliary fistula, intra-abdominal hemorrhage), ② postoperative mortality, ③ patients′ prognosis, ④ related indicators of postoperative pathology (lymph node metastasis rate, moderate- and low-differentiated rate, nerve invasion rate, negative rate of 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 meta-analysis, and the total sample size was 1 668 cases including 437 in the vein group and 1 231 in the no vascular group. (2) Results of Meta-analysis: ① incidence of postoperative complications was respectively 39.86% in the vein group and 35.27% in the no vascular 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 intra-abdominal hemorrhage were postoperative main complications, and the incidences were 17.09%, 8.79%, 6.25% in the vein group and 10.62%, 9.69%, 2.51% in the no vascular 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 vein group and 3.88% in the no vascular 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). The nerve invasion rate was 83.47% in the vein group and 64.90% in the no vascular group, with a statistically significant difference between the 2 groups (OR=2.61, 95%CI: 1.45- 4.70, P<0.05). Conclusion Combined vein and reconstruction is safe and feasible in the treatment of cholangiocarcinoma, and the prognosis of patients with vein invasion is worse than that without vein invasion. Key words: Biliary neoplasms, hilar; Portal vein resection; Meta-analysis