title: Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus.
abstract: BACKGROUND
  This meta-analysis aimed to compare perioperative and survival outcomes in patients who underwent hepatectomy with and without Bile Duct Tumour Thrombus (BDTT).
  
  
  METHODS
  A comprehensive search of Cochrane Library, PubMed, MEDLINE and EMBASE was performed to identify relevant articles. The perioperative, postoperative and long term outcomes were compared.
  
  
  RESULTS
  Eleven studies including 6051 patients met the inclusion criteria. The perioperative outcomes were comparable between the 2 groups. The BDTT group had higher proportion poorly differentiated tumours (OR = 1.87, X(2) = 10.00, df = 6, p = 0.002, I(2) = 40%), Lymphovascular invasion (LVI) (OR = 4.85, X(2) = 28.21, df = 9, p = <0.001, I(2) = 68%) and Macrovascular invasion (MVI) (OR = 5.41, X(2) = 8.73, df = 9, p = <0.001, I(2) = 0%). There was no difference in 1 and 3 year survival, however 5-yr survival was poorer in the BDTT group (OR = 0.37, X(2) = 37.04, df = 7, p = <0.001, I(2) = 81%). The mean difference (MD) in overall survival in the BDTT group was -20 months [-32.31, -7.06], p = 0.002, I(2) = 95%.
  
  
  CONCLUSIONS
  Patients with HCC with BDTT had more advanced stage HCC with adverse histological features including higher rates of MVI, LVI and poor differentiation. Hepatectomy in this group of patients offers similar survival at 3 years but inferior long-term survival and should be considered when feasible.
authors.affiliation: Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Suresh
authors.initials: S
authors.lastname: Navadgi
authors.affiliation: Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Chi-Chun
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Adam
authors.initials: A
authors.lastname: Bartlett
authors.affiliation: Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: McCall
authors.affiliation: Department of Hepatobiliary Surgery, Auckland City Hospital, Auckland, New Zealand; New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: Sanjay.pandanaboyana@gmail.com.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandanaboyana
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D002779:Cholestasis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome