Survival after surgical resection of distal cholangiocarcinoma: A systematic review and meta-analysis of prognostic factors

Abstract

Background/Objective: This study aimed to assess the available evidence on the survival of distal cholangiocarcinoma (DCC) patients following resection with curative intent and analyze the prognostic factors. Methods: Relevant studies published between January 2000 and January 2015 were identified by searching PubMed and Embase and reviewed systematically. Summary relative risks (RR) and 95% confidence intervals (95% CI) were estimated using random-effects models. Results: A total of 39 observational studies involving 3258 patients were included in the review. R0 resection was achieved in 84% (range, 46–100%) of patients. The median 5-year overall survival rate after resection was 37% (range, 13–54%), with corresponding rate of 44% (range, 27–63%) in R0 resection. The meta-analysis for 25 studies showed that R1 resection (RR 2.36, 95% CI 1.89–2.93), lymph node metastasis (RR 2.35, 95% CI 1.89–2.93), perineural invasion (RR 1.96, 95% CI 1.64–2.34), lymphatic invasion (RR 1.84, 95% CI 1.47–2.31), vascular invasion (RR 1.99, 95% CI 1.40–2.82), pancreatic invasion (RR 2.13, 95% CI 1.39–3.27), and pathological tumor stage ≥ T3 (RR 1.56, 95% CI 1.25–1.93) were associated with shorter survival. Conclusion: In general, prognosis of DCC after resection is poor. R0 resection results in a substantially improved survival and represents one of the most important prognostic variables.

Keywords

• distal cholangiocarcinoma
• prognostic factors
• resection
• survival