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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Laparoscopic vs open radical resection in management of gallbladder carcinoma: A systematic review and meta-analysis
Shilin He, Tu-Nan Yu, Jia-Sheng Cao, Xue-Yin Zhou, Zhe-Han Chen, Wen-Bin Jiang, Liu-Xin Cai, Xiao Liang
Shilin He, Tu-Nan Yu, Jia-Sheng Cao, Xue-Yin Zhou, Wen-Bin Jiang, Liu-Xin Cai, Xiao Liang, Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
Xue-Yin Zhou, School of Medicine, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Zhe-Han Chen, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Zhe-Han Chen, Department of Hepatobiliary Surgery, Fuyang First People’s Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 311400, Zhejiang Province, China
Author contributions: He S acquired, analyzed, and interpreted the data, drafted the manuscript, and approved the final manuscript; Yu TN, Cao JS, and Cai LX revised the manuscript and approved the final manuscript; Zhou XY and Chen ZH interpreted the data, revised the manuscript, and approved the final manuscript; Jiang WB acquired and interpreted the data, and approved the final manuscript; Liang X conceptualized and designed the study, critically revised the manuscript, and approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Xiao Liang, MD, PhD, Attending Doctor, Professor, Surgeon, Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. srrshlx@zju.edu.cn
Received: May 20, 2023
Peer-review started: May 20, 2023
First decision: June 15, 2023
Revised: June 29, 2023
Accepted: July 24, 2023
Article in press: July 24, 2023
Published online: September 26, 2023
BACKGROUND
Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma (GBC) above the T1b stage. However, whether it should be performed under laparoscopy for GBC is still controversial.
AIM
To compare laparoscopic radical resection (LRR) with traditional open radical resection (ORR) in managing GBC.
METHODS
A comprehensive search of online databases, including Medline (PubMed), Cochrane Library, and Web of Science, was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023. A meta-analysis was subsequently performed.
RESULTS
A total of 18 retrospective studies were identified. In the long-term prognosis, the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival (TFS). LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis (TNM) Ⅱ stage subgroup vs the ORR group (P = 0.04). In the short-term prognosis, the LRR group had superiority over the ORR group in the postoperative length of stay (POLS) (P < 0.001). The sensitivity analysis showed that all pooled results were robust.
CONCLUSION
The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNM Ⅱ disease and POLS. Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.
Core Tip: Using laparoscopic surgery to treat gallbladder carcinoma (GBC) is still controversial. This is the first meta-analysis to directly compare laparoscopic radical resection and open radical resection in GBC. Unlike previous similar meta-analyses, we excluded interference from simple cholecystectomy cases in our study and conducted a subgroup analysis. We also tested the publication bias and conducted a sensitivity analysis.
