The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Lv, Tian-Run; Liu, Fei; Hu, Hai-Jie; Regmi, Parbatraj; Ma, Wen-Jie; Yang, Qing; Jin, Yan-Wen; Li, Fu-Yu
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 3(2022)
• Page Start: 482
• Page End: 491
• Publication Date: 2022-03
• Subjects: Gallbladder carcinoma -- Bile duct resection -- Extra-hepatic bile duct resection -- Common bile duct resection; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.11.131
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Objective: 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. Methods: PubMed, EMBASE and the Cochrane Library were searched up to March 1 st 2021 for comparative studies between bile duct resected and non-resected groups. RevMan5.3 and Stata 13.0 software were used for the statistical analyses. Results: EHBDR 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). Conclusion: 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.