Erschienen in:
09.04.2020 | Hepatobiliary Tumors
Surgical Strategies for the Treatment of Bismuth Type I and II Hilar Cholangiocarcinoma: Bile Duct Resection with or Without Hepatectomy?
verfasst von:
Rui Xiang Chen, MBBS, Chang Xian Li, PhD, Cheng Huan Luo, MBBS, Hui Zhang, MBBS, Tao Zhou, MBBS, Xiao Feng Wu, PhD, Xue Hao Wang, PhD, Xiang Cheng Li, PhD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 9/2020
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Abstract
Background
The role of hepatic resection in the treatment of type I and II hilar cholangiocarcinoma (HCCA) remains controversial. In the present study, we aimed to identify whether hepatic resection was necessary for type I and II HCCA.
Methods
A total of 23 patients classified as type I and II HCCA undergoing surgical resection were included in this study. The patients were divided into two groups: bile duct resection (BDR) group (n = 15) and hepatic resection (HR) group (n = 8). Systematic review and meta-analysis were performed to compare the R0 resection and long-term survival between BDR and HR for Bismuth type I and II HCCA. A total of 7 studies with 260 cases were included in this meta-analysis.
Results
In our cohort, the R0 resection rate was 73.3% in BDR group and 87.5% in HR group. The HR group had a higher number of postoperative complications than the BDR group (P = 0.002). There was no difference in long-term survival (P = 0.544) and recurrence (P = 0.846) between BDR and HR in Bismuth type I and II HCCA. The meta-analysis showed that HR was associated with better R0 resection rate (RR 4.45, 95% CI 2.34–8.48) and overall survival (HR 2.15, 95% CI 1.34–3.44) compared with BDR group. There was no publication bias and undue influence of any single study.
Conclusions
The meta-analysis showed that HR was associated with better R0 resection rate and overall survival compared with BDR for type I and II HCCA patients. More aggressive surgical strategies should be increasingly considered for the treatment of type I and II HCCA patients.