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Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis

Published:January 10, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.008

      Highlights

      • Gallbladder carcinoma (GBC) is considered a highly lethal disease.
      • Laparoscopic surgery is non-inferior to open approach oncological outcomes.
      • Laparoscopic surgery is associated with fewer postoperative complications.
      • Laparoscopic surgery is comparable to open surgery in terms of overall survival.

      Abstract

      Background

      This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC).

      Methods

      Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs.

      Results

      There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG.

      Conclusion

      Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.

      Keywords

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