The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis

Autor: Fei Liu, Qing Yang, Wen-Jie Ma, Hai-Jie Hu, Parbatraj Regmi, Fu-Yu Li, Tian-Run Lv, Yan-Wen Jin
Rok vydání: 2022
Předmět:
Zdroj: European Journal of Surgical Oncology. 48:482-491
ISSN: 0748-7983
DOI: 10.1016/j.ejso.2021.11.131
Popis: To systematically evaluate the clinicopathological and prognostic value of extra-hepatic bile duct resection (EHBDR) in the surgical management of patients with gallbladder carcinoma (GBC), especially in non-jaundiced patients.PubMed, EMBASE and the Cochrane Library were searched up to March 1EHBDR did not correlate with a better overall survival (OS) (P = 0.17) or disease-free survival (P = 0.27). No survival benefit was also observed in patients with T2N1 (P = 0.4), T3N0 (P = 0.14) disease and node-positive patients (P = 0.75), rather, EHBDR was even harmful for patients with T2N0 (P = 0.01) and node-negative disease (P = 0.02). Significantly higher incidences of recurrent disease (P = 0.0007), postoperative complications (P 0.00001) and positive margins (P = 0.02) were detected in the bile duct-resected group. The duration of postoperative hospital stay between the two groups was comparable (P = 0.58). Selection bias was also detected in our analysis that a significantly higher proportion of advanced lesions with T3-4 or III-IV disease was observed in the bile duct-resected group (P 0.00001). EHBDR only contributed to a greater lymph yield (P = 0.01).EHBDR has no survival advantage for patients with GBC, especially for those with non-jaundiced disease. Considering the unfairness of comparing OS between jaundiced patients receiving EHBDR with non-jaundiced patients without EHBDR, we could only conclude that routine EHBDR in non-jaundiced patients is not recommended and future well-designed studies with more specific subgroup analyses are required for further validation.
Databáze: OpenAIRE
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