Systematic review and meta-analysis of surgery for hilar cholangiocarcinoma with arterial resection (Preprint)

BACKGROUND With the advances in multimodality treatment in the recent years, an analysis of the outcome of vascular resections in surgery of hilar cholangiocarcinoma is lacking. OBJECTIVE The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma. METHODS A systematic literature search in the databases PubMed/Medline, Cochrane Library, Cinahl and the trial registries ClinicalTrials.gov and WHO ICTRP will be carried out. RESULTS Pre-defined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication), vascular complications (thrombosis or stenosis of the portal vein or hepatic artery, pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3- and 5-year survival), complete/incomplete resection rates, histologic arterial invasion and lymph node positivity (number of positive lymph nodes and lymph node ratio). CONCLUSIONS Our findings will enable us to present the current evidence on feasibility, safety and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. These data will support healthcare professionals in their clinical decision-making. CLINICALTRIAL PROSPERO ID 223396

Radical Resection for Locally Advanced Pancreatic Cancers in the Era of New Neoadjuvant Therapy—Arterial Resection, Arterial Divestment and Total Pancreatectomy

Aggressive arterial resection (AR) or total pancreatectomy (TP) in surgical treatment for locally advanced pancreatic cancer (LAPC) had long been discouraged because of their high mortality rate and unsatisfactory long-term outcomes. Recently, new chemotherapy regimens such as FOLFIRINOX or Gemcitabine and nab-paclitaxel have provided more adequate patient selection and local tumor suppression, justifying aggressive local resection. In this review, we investigate the recent reports focusing on arterial resection and total pancreatectomy for LAPC and discuss the rationale of such an aggressive approach in the treatment of PC. AR for LAPCs is divided into three, according to the target vessel. The hepatic artery resection is the simplest one, and the reconstruction methods comprise end-to-end, graft or transposition, and no reconstruction. Celiac axis resection is mainly done with distal pancreatectomy, which allows collateral arterial supply to the liver via the pancreas head. Resection of the superior mesenteric artery is increasingly reported, though its rationale is still controversial. Total pancreatectomy has been re-evaluated as an effective option to balance both the local control and postoperative safety. In conclusion, more and more aggressive pancreatectomy has become justified by the principle of total neoadjuvant therapy. Further technical standardization and optimal neoadjuvant strategy are mandatory for the global dissemination of aggressive pancreatectomies.

Systematic Review and Meta-analysis of Surgery for Hilar Cholangiocarcinoma With Arterial Resection

Objective: With the advances in multimodality treatment in the recent years, an analysis of the outcome of vascular resections in surgery of hilar cholangiocarcinoma is lacking. The aim of this meta-analysis was to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma.Methods: A systematic literature search from PubMed/Medline, Cochrane Library, Cinahl, ClinicalTrials.gov (clinical trials registry) and WHO ICTRP (clinical trials registry,) databases will be carried out. PRISMA guidelines will be followed. Pre-defined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication, surgical and medical), vascular complications (thrombosis of the portal vein or hepatic artery, stenosis of these vessels, and pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3- and 5-year survival), R0/R1/R2 resection rates, proportion of patients with no resection during surgery, rate of histologic arterial invasion and lymph node positivity (number of positive lymph nodes and lymph node ratio). Discussion: Our findings will enable us to present the current evidence on feasibility, safety and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. These data will support healthcare professionals in their clinical decision-making.Systematic review registration: PROSPERO ID 223396