Patients with perihilar cholangiocarcinoma (CCA) may have improved outcomes after receiving caudate lobe resection during curative surgical management, according to an article published in Annals of Surgical Oncology.

In the systematic review and meta-analysis study, caudate lobe resection increased the likelihood of achieving margin-negative (R0) resection and improved overall survival (OS) without increasing perioperative morbidity.

“The current review supports routine caudate lobectomy in addition to hepatic resection and extrahepatic bile duct resection in the surgical management of [perihilar CCA],” the authors said.


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Patients with perihilar CCA who underwent caudate lobe resection in addition to hepatectomy and bile duct resection had an over 5 times greater odds of achieving R0 resection (odds ratio [OR], 5.85; 95% CI 2.64-12.95) compared to patients who had hepatectomy without caudate lobe resection. These results were based on a meta-analysis of 5 studies and included 541 patients.

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The achievement of R0 resection has previously been demonstrated to be the strongest predictor of survival after resection for these patients, yet it has often proved to be challenging to achieve.

The OS of patients receiving caudate lobe resection was significantly better than those who did not receive it (hazard ratio [HR], 0.65; 95% CI, 0.54-0.79; P <.0001] based on the meta-analysis of 723 patients from 6 studies. The inclusion of only high-quality studies (n=3) involving 344 patients yielded similar OS results (HR, 0.67; 95% CI, 0.49-0.91; P =.01).

In the 4 studies that reported surgical complications, none showed a significant difference between those patients who received caudate lobe resection and those who did not. Meta-analysis pooling the data from all 4 studies also did not show a difference in postoperative morbidity between the 2 groups (OR, 1.03; 95% CI, 0.65-1.63; P =.89).

“These results should be interpreted with caution given the lack of available high-quality prospective data and the high probability of selection bias. Prospective studies with careful control of confounding are needed to specifically address the paucity of robust data pertaining to additive surgical morbidity associated with caudate resection in [perihilar CCA],” the authors concluded.

Reference

Gilbert RWD, Lenet T, Cleary SP, et al. Does caudate resection improve outcomes of patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis. Ann Surg Oncol. Published online June 15, 2022. doi:10.1245/s10434-022-11990-7