BACKGROUND: The optimal surgical extent for T1 gallbladder cancer (GBC) remains controversial. Simple cholecystectomy is routinely performed for T1 GBC while several guidelines recommend extended cholecystectomy for T1b GBC. However, evidence regarding the optimal surgical extent for T1 GBC is lacking. This study aims to systematically evaluate the optimal surgical extent for early GBC with regard to long-term survival. METHODS: A comprehensive literature search in MEDLINE was performed to identify studies with histologically proven GBC and survival data. A total of 22 articles with a total of 2,578 patients were included in the final analysis. Dichotomous data regarding cancer-related death in all T1, T1a, and T1b GBC cases were extracted. Risk ratios, risk differences, and 95% confidence intervals (CIs) were pooled. RESULTS: The risk ratio between simple and extended cholecystectomy in T1 GBC patients was 1.06 (95% CI 0.97-1.16); T1a, 0.82 (95% CI 0.70-0.96); and T1b, 1.06 (95% CI 0.93-1.22). No significant difference was found according to the extent of surgery in all T1 or T1b GBC cases (P = 0.17 and P = 0.36, respectively). Simple cholecystectomy had significantly lower cancer-related death in T1a GBC patients (P = 0.01). CONCLUSION: Simple and extended cholecystectomy showed comparable survival outcomes in T1 GBC patients.
BACKGROUND: The optimal surgical extent for T1 gallbladder cancer (GBC) remains controversial. Simple cholecystectomy is routinely performed for T1 GBC while several guidelines recommend extended cholecystectomy for T1b GBC. However, evidence regarding the optimal surgical extent for T1 GBC is lacking. This study aims to systematically evaluate the optimal surgical extent for early GBC with regard to long-term survival. METHODS: A comprehensive literature search in MEDLINE was performed to identify studies with histologically proven GBC and survival data. A total of 22 articles with a total of 2,578 patients were included in the final analysis. Dichotomous data regarding cancer-related death in all T1, T1a, and T1b GBC cases were extracted. Risk ratios, risk differences, and 95% confidence intervals (CIs) were pooled. RESULTS: The risk ratio between simple and extended cholecystectomy in T1 GBC patients was 1.06 (95% CI 0.97-1.16); T1a, 0.82 (95% CI 0.70-0.96); and T1b, 1.06 (95% CI 0.93-1.22). No significant difference was found according to the extent of surgery in all T1 or T1b GBC cases (P = 0.17 and P = 0.36, respectively). Simple cholecystectomy had significantly lower cancer-related death in T1a GBC patients (P = 0.01). CONCLUSION: Simple and extended cholecystectomy showed comparable survival outcomes in T1 GBC patients.
Authors: T Peter Kingham; Victoria G Aveson; Alice C Wei; Jason A Castellanos; Peter J Allen; Daniel P Nussbaum; Yinin Hu; Michael I D'Angelica Journal: Curr Probl Surg Date: 2020-06-30 Impact factor: 1.909