Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis

Rebelo, Artur; Ukkat, Jörg; Klose, Johannes; Ronellenfitsch, Ulrich; Kleeff, Jörg

doi:10.2196/31212

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Therefore, thorough lymph node dissection is essential for these patients[ 10 ]. It is particularly important to optimize the technology used for modular and en bloc clearance of the hepatic hilar region[ 11 , 12 ]; (3) A high rate of surgical margin positivity: Due to the particularity of the tumor location and invasiveness, the rate of surgical margin positivity is relatively high in Bismuth-Corlette type III and IV HCCA patients, which further increases the risk of postoperative recurrence[ 13 , 14 ]; and (4) A high risk of intraoperative bleeding: Due to the extensive vascular network in the hepatic hilar area, complex anatomical variation factors, and the requirement for extensive hepatectomy, the risk of intraoperative bleeding is high[ 15 , 16 ]. Therefore, strict intraoperative vascular protection and control are essential in Bismuth-Corlette type III and IV HCCA patients.…”

Section: Discussionmentioning

confidence: 99%

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

Hu,

Wang,

Pan

et al. 2024

World J Gastrointest Surg

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BACKGROUND In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention. AIM To summarize and share the application experience of the emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV. METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed. RESULTS Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of “hepatic hilum area dissection priority, liver posterior separation first”. The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications. CONCLUSION The emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.

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Section: Discussionmentioning

confidence: 99%

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

Hu,

Wang,

Pan

et al. 2024

World J Gastrointest Surg

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“…To assess the currently available evidence on the effect of FAP expression on survival and clinical characteristics in GI cancers, we plan to conduct a systematic review and meta-analysis. With this research protocol, we further aim to achieve reproducibility and transparency of our meta-analysis on the published literature as previously demonstrated [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Fibroblast Activation Protein Overexpression in Gastrointestinal Tumors: Protocol for a Systematic Review and Meta-analysis

Sunami¹,

Ronellenfitsch²,

Kleeff³

et al. 2023

JMIR Res Protoc

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Background A hallmark of gastrointestinal cancer, especially pancreatic cancer, is the dense stromal tumor microenvironment in which cancer-associated fibroblasts (CAFs) represent the major stromal cell type. Preclinical studies have demonstrated that depletion of fibroblast activation protein (FAP)–positive CAFs results in increased survival. Objective We present the protocol for a systematic review and meta-analysis that aim to assess the currently available evidence on the effect of FAP expression on survival and clinical characteristics in gastrointestinal cancers. Methods The literature search and data analysis will be conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. The databases PubMed/MEDLINE, Web of Science Core Collection, Cochrane Library, and ClinicalTrials.gov will be searched via their respective online search engines. A meta-analysis comparing patients with and without FAP overexpression with the following outcomes will be performed: postoperative survival (overall and median survival; 1-, 2-, 3-, and 5-year survival rates), histological differentiation (grading), local tumor invasion, lymph node metastases, and distant metastases. Odds ratios will be calculated for binary data, and weighted mean differences and relative SD differences will be determined for continuous data. The 95% CI, heterogeneity measures, and statistical significance will be reported for each outcome. The chi-square and Kruskal-Wallis tests will be used to evaluate statistical significance. A P value of <.05 will be considered statistically significant. Results Database searches will commence in April 2023. The meta-analysis will be completed by December 2023. Conclusions In recent years, several publications on FAP overexpression in gastrointestinal tumors have been published. The only published meta-analysis on this topic dates to 2015. It included 15 studies on various solid tumors and only 8 studies focusing exclusively on gastrointestinal tumors. The expected results of the present analysis will provide new evidence on the prognostic value of FAP in gastrointestinal tumors and thereby support health care professionals and patients in their decision-making. Trial Registration PROSPERO CRD42022372194; https://tinyurl.com/352ae8b8 International Registered Report Identifier (IRRID) PRR1-10.2196/45176

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“…As for the issue of vascular resection, if resection and reconstruction are possible, combined vascular resection can be performed with an acceptable mortality rate and can offer long-term survival to some patients with advanced HC previously considered inoperable 19,20 . Combined procedures should be encouraged as an option to cure intractable disease as suggested by a meta-analysis 21 . Nowadays, surgical treatment of HC has steadily evolved, with decreasing mortality and increasing survival rates.…”

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confidence: 99%

Análisis pronóstico y resultado del colangiocarcinoma hiliar tras la resección radical: un estudio retrospectivo

Xu,

Zhou,

Guan

et al. 2023

CIRU

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Objectives:The predictive factors affecting the survival of hilar cholangiocarcinoma (HC) are ambiguous. This study aimed to identify the predictors and recurrence patterns of HC. Methods: A retrospective analysis of the clinicopathological findings of 126 patients with HC from 2009 to 2019 was performed. Results: The proportion of Bismuth I and II HC in the recurrence group was higher than that in the non-recurrence group (p < 0.01). The recurrence group had poorer tumor differentiation, a more advanced N stage, and a higher incidence of perineural invasion compared with the non-recurrence group. N stage and tumor differentiation were independently associated with disease-free and overall survival of patients (p < 0.01). Bile duct resection (BDR) combined with hepatectomy was more favorable to disease-free and overall survivals than BDR alone in Bismuth I and II HC, although p values were marginal (p = 0.072 and p = 0.045). A higher proportion of patients in the non-recurrence group underwent BDR combined with hepatectomy than that in the recurrence group (p < 0.01). Conclusions: N stage and tumor differentiation are the two independent predictors of patient survival. BDR combined with hepatectomy is recommended for patients with Bismuth I and II hilar cholangiocarcinoma.

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Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis

Cited by 4 publications

References 15 publications

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

Fibroblast Activation Protein Overexpression in Gastrointestinal Tumors: Protocol for a Systematic Review and Meta-analysis

Análisis pronóstico y resultado del colangiocarcinoma hiliar tras la resección radical: un estudio retrospectivo

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