Systematic review and meta-analysis of surgery for hilar cholangiocarcinoma with arterial resection.

Abstract

With the advances in multimodality treatment, an analysis of the outcome of arterial resections (AR) in surgery of cholangiocarcinoma is lacking. The aim of this meta-analysis was to summarize the currently available evidence onof AR for the treatment of cholangiocarcinoma. A systematic literature search was carried out according to PRISMA guidelines. 10 retrospective cohort studies published from 2007 to 2020 with 2530 patients (408 AR group and 2122 control group) were identified. Higher in-hospital mortality rates (6.8% vs 3.3%, OR 2.65, 95% CI [1.27; 5.32], p=0.009), higher morbidity rates (Clavien-Dindo classification ≥3 ) (52% vs 47%, OR 1.44, 95% CI [1.02; 1.75], p=0.04) and lower 1-year, 3-year and 5-year survival rates (54% vs 69%, OR 0.55, 95% CI [0.34; 0.91 p=0.02), (34% vs 38%, OR 0.74, 95% CI [0.55; 0.98, p=0.03), (18% vs 29%, OR 0.54, 95% CI [0.39; 0.75, p=0.0002) were observed in the AR group when compared to the control group. Evidence from non-randomized studies shows a higher morbidity and mortality and shorter long-term survival in patients undergoing AR. However, the results are prone to selection bias, and only randomized trials comparing AR and palliative treatments AR might reveal a possible benefit of AR. PROSPERO ID 223396.