Value of partial hepatectomy for the treatment of hilar cholangiocarcinoma: a Meta-analysis study*

Abstract

Abstract Objective To discuss the value of partial hepatectomy in patients with hilar cholangiocarcinoma. Methods English articles related to hilar cholangiocarcinoma were screened from January 1, 1990 to May 12, 2019 in the PubMed, MEDLINE, EMBASE, and Cochrane Library databases. Information on postoperative radical cure, survival, morbidity, and mortality after surgery were extracted from articles that met the inclusion criteria for the meta-analysis. Results Twenty-two articles that met the inclusion criteria were classified into 4 study groups: the hepatectomy radical cure group (19 articles), the hepatectomy survival group (16 articles), the hepatectomy morbidity group (9 articles), and the hepatectomy mortality group (17 articles). We found that the rate of radical cure after partial hepatectomy (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.20-0.51) and the survival rate (hazard ratio [HR] 0.67, 95% CI 0.58-0.79) were significantly higher than after simple bile duct resection, but that morbidity (OR 1.99, 95% CI 1.37-2.90) and mortality (OR 2.71, 95% CI 1.47-4.98) in patients within the partial hepatectomy group were also higher than in the simple bile duct resection group, taking into account the significant heterogeneity in the articles pertaining to the hepatectomy radical cure group (I 2 = 68.3%, P = 0.000), a sub-group analysis was subsequently conducted. Its results showed that when the branches of the secondary bile ducts were not involved during hilar cholangiocarcinoma, then a bile duct resection had a similar radical cure outcome as combined partial hepatectomy (OR 0.94, 95% CI 0.54-1.65). Conclusion Partial hepatectomy can increase the proportion of radical cure in patients with hilar cholangiocarcinoma and extend the survival time after surgery. However, the morbidity and mortality after surgery are higher than those in simple bile duct resections. Therefore, simple bile duct resection is still a relevant and efficient tool in the treatment of Bismuth-Corlette Type I and II hilar cholangiocarcinomas.