A systematic review and meta-analysis of caudate lobectomy for treatment of hilar cholangiocarcinoma
A partir d'une revue systématique de la littérature (8 études, 1 350 patients au total), cette méta-analyse évalue l'intérêt, du point de vue de l'amélioration de la survie à long terme, d'une résection du lobe caudé chez les patients atteints d'un cholangiocarcinome hilaire
Background : Surgical resection remains the only potentially curative therapy for hilar cholangiocarcinoma (CCC) patients. This meta-analysis aimed to review the current evidence on perioperative and long-term outcomes of routine caudate lobe resection (CLR) for surgical treatment of hilar CCC. Methods : A systematic literature search using MEDLINE, EMBASE and Cochrane databases was performed for studies providing comparative data on perioperative and long-term outcomes of patients undergoing resection for hilar CCC with and without CLR. The MINORS score was used for quality assessment. For time-to-event outcomes hazard ratios (HRs) and associated 95% CI were extracted from identified studies, whereas risk ratios (RRs) were calculated for overall morbidity, mortality, and resection margin status. Meta-analyses were carried out using random-effects models. Results : Eight studies involving 1350 patients met the inclusion criteria. The quality of the included studies was low to moderate. CLR resulted in significantly improved overall survival (HR 0.49; 95%CI 0.32–0.75, P < 0.01). Postoperative morbidity (RR 0.93; 95% CI 0.77–1.13; P = 0.48) and mortality (RR 1.01; 95% CI 0.42–2.41; P = 0.99) rates were comparable between both groups. Patients without concomitant CLR were at higher risk for residual tumor at the resection margin (RR 1.40; 95% CI 1.09–1.80; P = 0.01). Conclusion : CLR is associated with improved long-term survival and negative tumor margins after resection of hilar CCC with no adverse impact on perioperative outcomes. CLR might provide the potential to become a standard-of-care procedure in the surgical management of hilar CCC.