Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2022; 14(12): 1387-1396
Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1387
Short- and long-term outcomes of laparoscopic vs open surgery for T2 gallbladder cancer: A systematic review and meta-analysis
Wei Zhang, De-Liang Ouyang, Xu Che
Wei Zhang, Xu Che, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
De-Liang Ouyang, Department of General Surgery, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421900, Hunan Province, China
Author contributions: Zhang W and Ouyang DL equally contributed to this work; Zhang W and Ouyang DL drafted the manuscript and acquired and interpreted the data; Che X designed the study and revised the manuscript.
Supported by Shenzhen High-Level Hospital Construction Fund, and Sanming Project of Medicine in Shenzhen, No. SZSM202011010.
Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: This meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The data used in this study were derived from published studies and are anonymous. This study did not need informed consent from patients or a review by an institutional ethics committee. This meta-analysis was registered under the registration number CRD42022367334 on the systematic review registration platform PROSPERO (https://www.crd.york.ac.uk/PROSPERO/).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu Che, MD, Associate Professor, Chief Doctor, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 113 Baohe Avenue, Longgang District, Shenzhen 518116, Guangdong Province, China. yixuetg@foxmail.com
Received: September 25, 2022
Peer-review started: September 25, 2022
First decision: October 20, 2022
Revised: October 28, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: December 27, 2022
Processing time: 93 Days and 5.6 Hours
Abstract
BACKGROUND

With the development of laparoscopic techniques, gallbladder cancer (GBC) is no longer a contraindication to laparoscopic surgery (LS). Although LS is recommended for stage T1 GBC, the value of LS for stage T2 GBC is still controversial.

AIM

To evaluate the short- and long-term outcomes of LS in comparison to those of open surgery (OS) for stage T2 GBC.

METHODS

We searched the PubMed, Embase, Cochrane Library, Ovid, Google Scholar, and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC, with a cutoff date of September 2022. The Stata 15 statistical software was used for analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated to assess binary and continuous outcome indicators, respectively. Begg’s test and Egger’s test were used for detecting publication bias.

RESULTS

A total of five studies were included, with a total of 297 patients, 153 in the LS group and 144 in the OS group. Meta-analysis results showed that the LS group was better than the OS group in terms of operative time [WMD = -41.29, 95% confidence interval (CI): -75.66 to -6.92, P = 0.02], estimated blood loss (WMD = -261.96, 95%CI: -472.60 to -51.31, P = 0.01), and hospital stay (WMD = -5.67, 95%CI: -8.53 to -2.81, P = 0.0001), whereas there was no significant difference between the two groups in terms of blood transfusion (RR = 0.60, 95%CI: 0.31-1.15, P = 0.13), complications (RR = 0.72, 95%CI: 0.39-1.33, P = 0.29), number of lymph nodes retrieved (WMD = –1.71, 95%CI: -4.27 to -0.84, P = 0.19), recurrence (RR = 0.41, 95%CI: 0.06-2.84, P = 0.36), 3-year and 5-year overall survival (RR = 0.99, 95%CI: 0.82-1.18, P = 0.89 and RR = 1.02, 95%CI: 0.68-1.53, P = 0.92; respectively), and 3-year and 5-year disease-free survival (RR = 1.01, 95%CI: 0.84-1.21, P = 0.93 and RR = 1.15, 95%CI: 0.90-1.46, P = 0.26; respectively).

CONCLUSION

The long-term outcomes of LS for T2 GBC are similar to those of OS, but LS is superior to OS in terms of operative time, intraoperative bleeding, and postoperative hospital stay. Nevertheless, these findings should be validated via high-quality randomized controlled trials and longer follow-ups.

Keywords: Gallbladder cancer; T2 stage; Laparoscopic cholecystectomy; Oncological outcome; Meta-analysis

Core Tip: This study evaluated the safety and efficacy of laparoscopic surgery in comparison to those of open surgery for stage T2 gallbladder cancer. A total of five studies were included after retrieving various literature databases, with a cutoff date of September 2022. Meta-analysis results showed that the laparoscopic surgery group was better than the open surgery group in terms of operative time, estimated blood loss, and hospital stay, whereas there was no significant difference between the two groups in terms of blood transfusion, complications, number of lymph nodes retrieved, recurrence, and 3-year and 5-year overall and disease-free survival rates.