The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis
Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder canc...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
|
| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958421002621 |
| _version_ | 1818365939402407936 |
|---|---|
| author | Pipit Burasakarn Anuparp Thienhiran Sermsak Hongjinda Pusit Fuengfoo |
| author_facet | Pipit Burasakarn Anuparp Thienhiran Sermsak Hongjinda Pusit Fuengfoo |
| author_sort | Pipit Burasakarn |
| collection | DOAJ |
| description | Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66–5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1–8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57–1.01), (HR = 0.74, 95% CI = 0.49–1.12), and DFS (RR = 0.99, 95% CI = 0.88–1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary. |
| first_indexed | 2024-12-13T22:28:14Z |
| format | Article |
| id | doaj.art-40277d06f7414ce4a7b2d09b6bd83f08 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-12-13T22:28:14Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-40277d06f7414ce4a7b2d09b6bd83f082022-12-21T23:29:08ZengElsevierAsian Journal of Surgery1015-95842022-01-014513338The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysisPipit Burasakarn0Anuparp Thienhiran1Sermsak Hongjinda2Pusit Fuengfoo3Corresponding author.; Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, ThailandDivision of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, ThailandDivision of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, ThailandDivision of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, ThailandExtensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66–5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1–8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57–1.01), (HR = 0.74, 95% CI = 0.49–1.12), and DFS (RR = 0.99, 95% CI = 0.88–1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary.http://www.sciencedirect.com/science/article/pii/S1015958421002621Gall bladder cancerSurgeryExtended cholecystectomyCholecystectomyHepatectomy |
| spellingShingle | Pipit Burasakarn Anuparp Thienhiran Sermsak Hongjinda Pusit Fuengfoo The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis Asian Journal of Surgery Gall bladder cancer Surgery Extended cholecystectomy Cholecystectomy Hepatectomy |
| title | The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis |
| title_full | The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis |
| title_fullStr | The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis |
| title_full_unstemmed | The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis |
| title_short | The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis |
| title_sort | optimal extent of surgery in t2 gallbladder cancer and the need for hepatectomy a meta analysis |
| topic | Gall bladder cancer Surgery Extended cholecystectomy Cholecystectomy Hepatectomy |
| url | http://www.sciencedirect.com/science/article/pii/S1015958421002621 |
| work_keys_str_mv | AT pipitburasakarn theoptimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT anuparpthienhiran theoptimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT sermsakhongjinda theoptimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT pusitfuengfoo theoptimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT pipitburasakarn optimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT anuparpthienhiran optimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT sermsakhongjinda optimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis AT pusitfuengfoo optimalextentofsurgeryint2gallbladdercancerandtheneedforhepatectomyametaanalysis |