title: Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma.
abstract: BACKGROUND
  The management of hilar cholangiocarcinoma has evolved over time and extended liver resection, including the caudate lobe, and major vascular resection and extended lymphadenectomy have become established practice. The benefit of vascular resection has not been investigated.
  
  
  METHODS
  A systematic search of the MEDLINE and EMBASE databases was used to identify studies. A systematic review and a meta-analysis of the available studies were conducted according to PRISMA guidelines. Odds ratios were calculated using the Mantel-Haenszel method. Primary outcome variables assessed included morbidity, mortality, vascular complications and the effect of vascular resection on longterm survival.
  
  
  RESULTS
  Of 411 search results, only 24 studies reported the results of vascular resection in hilar cholangiocarcinoma. Meta-analysis showed increased morbidity and mortality with hepatic artery resection. Portal vein resection was achievable with no impact on postoperative mortality. Vascular resection did not improve negative margin rates and had no impact on longterm survival.
  
  
  CONCLUSIONS
  Portal vein resection does not preclude curative resection; however, it is not routinely recommended unless there is suspicion of tumour invasion. There was no proven survival advantage with portal vein resection. Arterial resection results in higher morbidity and mortality with no proven benefit.
authors.affiliation: Department of Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. salehabbas@yahoo.com
authors.forename: Saleh
authors.initials: S
authors.lastname: Abbas
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
mesh_terms: D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality