Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis
Evidence regarding the optical surgical extent for Bismuth type I/II HCCA is lacking. we aims to evaluate the optimal surgical methods for Bismuth type I/II HCCA. Studies comparing bile duct resection (BDR) and BDR combined with liver resection (BDR + LR) for all types of HCCA patients were searched...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958422017511 |
| _version_ | 1797669963167694848 |
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| author | Ya-Fei Hu Hai-Jie Hu Tian-Run Lv Zhi-Qiang He Yu-Shi Dai Fu-Yu Li |
| author_facet | Ya-Fei Hu Hai-Jie Hu Tian-Run Lv Zhi-Qiang He Yu-Shi Dai Fu-Yu Li |
| author_sort | Ya-Fei Hu |
| collection | DOAJ |
| description | Evidence regarding the optical surgical extent for Bismuth type I/II HCCA is lacking. we aims to evaluate the optimal surgical methods for Bismuth type I/II HCCA. Studies comparing bile duct resection (BDR) and BDR combined with liver resection (BDR + LR) for all types of HCCA patients were searched for analyses, and 14 studies were finally included. The main outcomes were the R0 resection rate and overall survival (OS). For all types of HCCA patents, BDR + LR resulted with higher R0 resection rates when comparing with BDR only (RR = 0.70, 95%CI, 0.63–0.78), and patients with R0 resections had eight times longer median survival and more long-time survival outcomes (3 and 5 year OS) comparing to those with non-R0 resections. Bismuth I/II HCCA patients also showed longer median survival and 3-year OS after R0 resections (P = 0.04). Moreover, there was no significant difference in 3-year OS between BDR and BDR + LR (P = 0.89) and we additionally found BDR resulted in less mortality or morbidity rates. In Europe and US, they resulted the R0 resection rates could be comparable between BDR and BDR + LR (P = 0.18), and Bismuth type I HCCA accounted for 75.8%, while in Asia, BDR + LR still resulted with higher R0 resection rates (P < 0.0001) and the Bismuth type I HCCA accounted for only 40.3%. The surgical approaches may not directly impact patient prognosis, patients with R0 resections are usually associated with improved survival outcomes; for selected Bismuth type I/II HCCA, BDR may be an acceptable option with regard to lower morbidity and comparable R0 resection rate comparing with BDR + LR. |
| first_indexed | 2024-03-11T20:52:38Z |
| format | Article |
| id | doaj.art-48a1a5f53df64909ab6fbe546cc8e44b |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-03-11T20:52:38Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-48a1a5f53df64909ab6fbe546cc8e44b2023-10-01T05:57:34ZengElsevierAsian Journal of Surgery1015-95842023-10-01461041154123Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysisYa-Fei Hu0Hai-Jie Hu1Tian-Run Lv2Zhi-Qiang He3Yu-Shi Dai4Fu-Yu Li5Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, ChinaDepartment of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, ChinaDepartment of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, ChinaDepartment of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, ChinaDepartment of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, ChinaCorresponding author.; Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, ChinaEvidence regarding the optical surgical extent for Bismuth type I/II HCCA is lacking. we aims to evaluate the optimal surgical methods for Bismuth type I/II HCCA. Studies comparing bile duct resection (BDR) and BDR combined with liver resection (BDR + LR) for all types of HCCA patients were searched for analyses, and 14 studies were finally included. The main outcomes were the R0 resection rate and overall survival (OS). For all types of HCCA patents, BDR + LR resulted with higher R0 resection rates when comparing with BDR only (RR = 0.70, 95%CI, 0.63–0.78), and patients with R0 resections had eight times longer median survival and more long-time survival outcomes (3 and 5 year OS) comparing to those with non-R0 resections. Bismuth I/II HCCA patients also showed longer median survival and 3-year OS after R0 resections (P = 0.04). Moreover, there was no significant difference in 3-year OS between BDR and BDR + LR (P = 0.89) and we additionally found BDR resulted in less mortality or morbidity rates. In Europe and US, they resulted the R0 resection rates could be comparable between BDR and BDR + LR (P = 0.18), and Bismuth type I HCCA accounted for 75.8%, while in Asia, BDR + LR still resulted with higher R0 resection rates (P < 0.0001) and the Bismuth type I HCCA accounted for only 40.3%. The surgical approaches may not directly impact patient prognosis, patients with R0 resections are usually associated with improved survival outcomes; for selected Bismuth type I/II HCCA, BDR may be an acceptable option with regard to lower morbidity and comparable R0 resection rate comparing with BDR + LR.http://www.sciencedirect.com/science/article/pii/S1015958422017511Hilar cholangiocarcinoma (HCCA)Bile duct resection (BDR)Bismuth-corlette classificationLiver resection (LR)Hilar resection (HR) |
| spellingShingle | Ya-Fei Hu Hai-Jie Hu Tian-Run Lv Zhi-Qiang He Yu-Shi Dai Fu-Yu Li Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis Asian Journal of Surgery Hilar cholangiocarcinoma (HCCA) Bile duct resection (BDR) Bismuth-corlette classification Liver resection (LR) Hilar resection (HR) |
| title | Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis |
| title_full | Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis |
| title_fullStr | Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis |
| title_full_unstemmed | Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis |
| title_short | Should more aggressive surgical resection be considered in the treatment for Bismuth types I and II hilar cholangiocarcinoma? A meta-analysis |
| title_sort | should more aggressive surgical resection be considered in the treatment for bismuth types i and ii hilar cholangiocarcinoma a meta analysis |
| topic | Hilar cholangiocarcinoma (HCCA) Bile duct resection (BDR) Bismuth-corlette classification Liver resection (LR) Hilar resection (HR) |
| url | http://www.sciencedirect.com/science/article/pii/S1015958422017511 |
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