Resection of the caudate lobe for the treatment of hilar cholangiocarcinoma

INTRODUCTION: Whether the resection of the caudate lobe, in association with major hepatectomy, improves outcomes in hilar cholangiocarcinoma is controversial. EVIDENCE ACQUISITION: We performed a systematic literature review on all studies published from June 1979 to September 2016. Inclusion criteria for eligibility were the presence of parallel-groups of patients treated with major hepatectomy with either caudate lobe resection (CLR), or not (NCLR), in adult population, reporting data on overall survival (OS). We ran out a random-effect meta-analysis for survival data. EVIDENCE SYNTHESIS: Six retrospective studies with 969 patients (643 CLR and 326 NCLR) were included. The probability of death was significantly lower in CLR group than in NCLR group (HR 0.65; 95% CI: 0.44-0.97; P=0.035). The median survival time was in favor of CLR (WMD 3.46; 95% CI: 1.02-5.90, P=0.005]. Patients who underwent CLR were more likely to receive a R0 resection than those who did not (OR 8.26; 95% CI: 2.45-27.87; P=0.001). No moderator effects were detected at meta-regression for operative time, postoperative complication rate and pathologic findings. CONCLUSIONS: Despite the paucity of data and the retrospective nature of the included studies, our results suggest that major hepatectomy plus caudate lobe resection may improve the likelihood of R0 resection and the overall survival in patients with hilar cholangiocarcinoma.