Impact of combined vascular resection on short and long-term results following radical surgery for hilar cholangiocarcinoma: evidence from a systematic assessment

Abstract Objective To analyze the impact of portal vein resection (PVR) and hepatic artery resection (HAR) on the short-term and long-term outcomes of patients with hilar cholangiocarcinoma after surgery. Methods A comprehensive literature search was conducted in the PubMed, Embase, and Web of Science databases for studies published from inception until August 10, 2025, focusing on hilar cholangiocarcinoma involving PVR or HAR. Postoperative mortality, hazard ratios (HR) with 95% confidence intervals (CI) for overall survival (OS), 5-year survival rates, postoperative complications, and postoperative pathological findings were used to evaluate short-term and long-term patient outcomes. Results This meta-analysis included 20 studies, encompassing a total of 3,648 hilar cholangiocarcinoma cases. Survival analysis indicated that combined vascular resection was associated with increased perioperative mortality. However, neither PVR nor HAR impaired patient OS. For patients without portal vein invasion (PVI), the 5-year survival rate after PVR showed no statistically significant difference compared to the non-resection group. Conversely, patients with confirmed PVI who underwent PVR still had a poorer 5-year survival rate than the non-vascular resection group. Analysis of complications reveals no statistically significant increase in the overall incidence of postoperative complications associated with vascular resection, although an increasing trend was observed. Both PVR and HAR were associated with an increased incidence of postoperative liver failure. Conclusion Vascular resection itself does not affect the overall survival rate of hilar cholangiocarcinoma patients, but it may increase the risk of postoperative liver failure. In order to improve the R0 resection rate, it is necessary to actively perform vascular resection, including hepatic artery resection, when patients have surgical indications. After combined vascular resection, the monitoring and nursing of postoperative complications should be strengthened to avoid perioperative mortality caused by complications as much as possible.