Yanming Zhou1, Shuncui Liu2, Lupeng Wu2, Tao Wan2. 1. Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China. Electronic address: zhouymsxy@sina.cn. 2. Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
Abstract
BACKGROUND/ OBJECTIVE: This study aimed to assess the available evidence on the survival of distal cholangiocarcinoma (DCC) patients following resection with curative intent and analyze the prognostic factors. METHODS: Relevant studies published between January 2000 and January 2015 were identified by searching PubMed and Embase and reviewed systematically. Summary relative risks (RR) and 95% confidence intervals (95% CI) were estimated using random-effects models. RESULTS: A total of 39 observational studies involving 3258 patients were included in the review. R0 resection was achieved in 84% (range, 46-100%) of patients. The median 5-year overall survival rate after resection was 37% (range, 13-54%), with corresponding rate of 44% (range, 27-63%) in R0 resection. The meta-analysis for 25 studies showed that R1 resection (RR 2.36, 95% CI 1.89-2.93), lymph node metastasis (RR 2.35, 95% CI 1.89-2.93), perineural invasion (RR 1.96, 95% CI 1.64-2.34), lymphatic invasion (RR 1.84, 95% CI 1.47-2.31), vascular invasion (RR 1.99, 95% CI 1.40-2.82), pancreatic invasion (RR 2.13, 95% CI 1.39-3.27), and pathological tumor stage ≥ T3 (RR 1.56, 95% CI 1.25-1.93) were associated with shorter survival. CONCLUSION: In general, prognosis of DCC after resection is poor. R0 resection results in a substantially improved survival and represents one of the most important prognostic variables.
BACKGROUND/ OBJECTIVE: This study aimed to assess the available evidence on the survival of distal cholangiocarcinoma (DCC) patients following resection with curative intent and analyze the prognostic factors. METHODS: Relevant studies published between January 2000 and January 2015 were identified by searching PubMed and Embase and reviewed systematically. Summary relative risks (RR) and 95% confidence intervals (95% CI) were estimated using random-effects models. RESULTS: A total of 39 observational studies involving 3258 patients were included in the review. R0 resection was achieved in 84% (range, 46-100%) of patients. The median 5-year overall survival rate after resection was 37% (range, 13-54%), with corresponding rate of 44% (range, 27-63%) in R0 resection. The meta-analysis for 25 studies showed that R1 resection (RR 2.36, 95% CI 1.89-2.93), lymph node metastasis (RR 2.35, 95% CI 1.89-2.93), perineural invasion (RR 1.96, 95% CI 1.64-2.34), lymphatic invasion (RR 1.84, 95% CI 1.47-2.31), vascular invasion (RR 1.99, 95% CI 1.40-2.82), pancreatic invasion (RR 2.13, 95% CI 1.39-3.27), and pathological tumor stage ≥ T3 (RR 1.56, 95% CI 1.25-1.93) were associated with shorter survival. CONCLUSION: In general, prognosis of DCC after resection is poor. R0 resection results in a substantially improved survival and represents one of the most important prognostic variables.
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