Richard W D Gilbert1, Tori Lenet1,2, Sean P Cleary3, Rory Smoot3, Ching-Wei D Tzeng4, Flavio G Rocha5, Guillaume Martel1,2, Kimberly A Bertens6,7. 1. Liver and Pancreas Surgical Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, Ottawa, ON, Canada. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Division of Surgical Oncology, Oregon Health and Science University/Knight Cancer Institute, Portland, OR, USA. 6. Liver and Pancreas Surgical Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, Ottawa, ON, Canada. kbertens@toh.ca. 7. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. kbertens@toh.ca.
Abstract
BACKGROUND: Margin-negative (R0) resection is the strongest positive prognostic factor in perihilar cholangiocarcinoma (PHC). Due to its anatomic location, the caudate lobe is frequently involved in PHC. This review aimed to examine the impact of caudate lobe resection (CLR) in addition to hepatectomy and bile duct resection for patients with PHC. METHODS: The MEDLINE, EMBASE, and Cochrane databases were systematically reviewed from inception to October 2021 to identify studies comparing patients undergoing surgical resection with hepatectomy and bile duct resection with or without CLR for treatment of PHC. Outcomes included the proportion of patients achieving R0 resection, overall survival (OS), and perioperative morbidity. RESULTS: Altogether, 949 studies were screened. The review included eight observational studies reporting on 1137 patients. The patients who underwent CLR had a higher likelihood of R0 resection (odds ratio [OR], 5.85; 95% confidence interval [CI], 2.64-12.95) and a better OS (hazard ratio [HR], 0.65; 95% CI, 0.54-0.79) than those who did not. The use of CLR did not increase the risk of perioperative morbidity (OR, 1.03; 95% CI, 0.65-1.63). CONCLUSIONS: Given the higher likelihood of R0 resection, improved OS, and no apparent increase in perioperative morbidity, this review supports routine caudate lobectomy in the surgical management of PHC. These results should be interpreted with caution given the lack of high-quality prospective data and the high probability of selection bias.
BACKGROUND: Margin-negative (R0) resection is the strongest positive prognostic factor in perihilar cholangiocarcinoma (PHC). Due to its anatomic location, the caudate lobe is frequently involved in PHC. This review aimed to examine the impact of caudate lobe resection (CLR) in addition to hepatectomy and bile duct resection for patients with PHC. METHODS: The MEDLINE, EMBASE, and Cochrane databases were systematically reviewed from inception to October 2021 to identify studies comparing patients undergoing surgical resection with hepatectomy and bile duct resection with or without CLR for treatment of PHC. Outcomes included the proportion of patients achieving R0 resection, overall survival (OS), and perioperative morbidity. RESULTS: Altogether, 949 studies were screened. The review included eight observational studies reporting on 1137 patients. The patients who underwent CLR had a higher likelihood of R0 resection (odds ratio [OR], 5.85; 95% confidence interval [CI], 2.64-12.95) and a better OS (hazard ratio [HR], 0.65; 95% CI, 0.54-0.79) than those who did not. The use of CLR did not increase the risk of perioperative morbidity (OR, 1.03; 95% CI, 0.65-1.63). CONCLUSIONS: Given the higher likelihood of R0 resection, improved OS, and no apparent increase in perioperative morbidity, this review supports routine caudate lobectomy in the surgical management of PHC. These results should be interpreted with caution given the lack of high-quality prospective data and the high probability of selection bias.
Authors: John N Primrose; Richard P Fox; Daniel H Palmer; Hassan Z Malik; Raj Prasad; Darius Mirza; Alan Anthony; Pippa Corrie; Stephen Falk; Meg Finch-Jones; Harpreet Wasan; Paul Ross; Lucy Wall; Jonathan Wadsley; Jeff T R Evans; Deborah Stocken; Raaj Praseedom; Yuk Ting Ma; Brian Davidson; John P Neoptolemos; Tim Iveson; James Raftery; Shihua Zhu; David Cunningham; O James Garden; Clive Stubbs; Juan W Valle; John Bridgewater Journal: Lancet Oncol Date: 2019-03-25 Impact factor: 41.316
Authors: Gennaro Nuzzo; Felice Giuliante; Francesco Ardito; Ivo Giovannini; Luca Aldrighetti; Giulio Belli; Fabrizio Bresadola; Fulvio Calise; Raffaele Dalla Valle; Davide F D'Amico; Leandro Gennari; Stefano M Giulini; Alfredo Guglielmi; Elio Jovine; Riccardo Pellicci; Heinrich Pernthaler; Antonio D Pinna; Stefano Puleo; Guido Torzilli; Lorenzo Capussotti; Umberto Cillo; Giorgio Ercolani; Massimo Ferrucci; Laura Mastrangelo; Nazario Portolani; Carlo Pulitanò; Dario Ribero; Andrea Ruzzenente; Vincenzo Scuderi; Bruno Federico Journal: Arch Surg Date: 2012-01
Authors: Michelle L DeOliveira; Steven C Cunningham; John L Cameron; Farin Kamangar; Jordan M Winter; Keith D Lillemoe; Michael A Choti; Charles J Yeo; Richard D Schulick Journal: Ann Surg Date: 2007-05 Impact factor: 12.969
Authors: F Rassam; E Roos; K P van Lienden; J E van Hooft; H J Klümpen; G van Tienhoven; R J Bennink; M R Engelbrecht; A Schoorlemmer; U H W Beuers; J Verheij; M G Besselink; O R Busch; T M van Gulik Journal: Langenbecks Arch Surg Date: 2018-01-19 Impact factor: 3.445