Laparoscopic vs open radical resection in management of gallbladder carcinoma: A systematic review and meta-analysis

Table 1 Publication bias test of major measured outcomes

	No. of studies	No. of patients		Egger's test		Begg's test (continuity corrected)
		LRR	ORR	t	P > |t|	z	P > |z|
No. LNH	17	799	1209	-5.1	< 0.001	0.37	0.711
Operation time	16	564	764	1.57	0.139	0.86	0.392
Blood loss	14	489	689	-2.18	0.050	1.86	0.063
POLS	17	799	1209	-3.03	0.008	0.04	0.967
R0 rate	8	1609	1705	1.64	0.162	0.00	1.000
Complications	15	511	703	-1.67	0.119	1.29	0.198
Complications (Clavien-Dindo 3-4)	8	244	245	-1.85	0.162	0.73	0.462
OS	15	1299	1936	0.3	0.767	0.68	0.499
TFS	10	339	338	-1.04	0.329	0.36	0.721

No. LNH: Number of lymph node harvested; POLS: Postoperative length of stay; OS: Overall survival; TFS: Tumor-free survival; LRR: Laparoscopic radical resection; ORR: Open radical resection.

Table 2 Characteristics of included comparative studies

Ref.	Year	Country	Study design	NOS	Group	Patient (n)	Age	F/M	T stage/TNM stage(n)	Follow-up (mo)
Agarwal et al[32]	2015	India	Retrospective	7	LRR	24	44 (21-61)	17/7	Ⅰ: 3; Ⅱ: 10; Ⅲ: 11	18 (6-34)
					ORR	46	49 (23-70)	34/12	Ⅰ: 5; Ⅱ: 10; Ⅲ: 31
Feng et al[33]	2019	China	Retrospective	7	LRR	41	64 ± 14	17/24	Tis: 9; T1: 10; T2: 14; T3: 8	12 (2-93)
					ORR	61	66 ± 10	22/39	Tis: 4; T1: 9; T2: 1 32; T3: 16
Itano et al[34]	2015	Japan	Retrospective	6	LRR	16	68.1 ± 19.9	7/9	T1: 3; T2: 13	37
					ORR	14	71.5 ± 13.2	9/5	T1-T2: 14	48
Jang et al[35]	2019	Korea	Retrospective	7	LRR	55	70.1 ± 8.1	36/19	T2: 55	35.2 (3-139)
					ORR	44	65.5 ± 10.5	21/23	T2: 44	38.6 (4-160)
Nag et al[36]	2019	India	Retrospective	7	LRR	30	49.6 ± 12.8	27/3	T1: 8; T2: 8; T3: 8; T4: 2	NA
					ORR	38	49 ± 10.1	23/15	T1: 6; T2: 17; T3: 15; T4: 0	NA
Ong et al[37]	2017	United States	Retrospective	6	LRR	623	70 (61-79)	442/181	T1 + T2: 461; T3: 146; UKN: 16	NA
					ORR	882		587/295	T1 + T2: 469; T3: 374; UKN: 39	NA
Vega et al[38]	2019	United StatesChile	Retrospective	8	LRR	65	68 (59-76)	49/141	T1: 14; T2: 43; T3: 8	Survivors: 70.8 (95%CI: 53.6 to 87.3)
					ORR	190		11/54	T1: 5; T2: 126; T3: 39
Cao et al[46]	2021	China	Retrospective	8	LRR	53	61 (48-77)	35	T1b: 3; T2: 50	NA
					ORR	61	64 (39-79)	47	T1b: 5; T2: 56	NA
Dou et al[48]	2022	China	Retrospective	7	LRR (PSM)	30	> 60: 21	23	T2: 9; T3: 21	NA
					ORR (PSM)	30	> 60: 19	25	T2: 10; T3: 20	NA
Lee et al[43]	2022	Korea	Retrospective	8	LRR	20	71.85 ± 9.11	15	T1: 4; T2: 12; T3: 4	NA
					ORR	24	68.08 ± 10.64	13	T1: 5; T2: 16; T3: 3	NA
Navarro et al[41]	2020	Korea	Retrospective	7	LRR (PSM)	43	66.7 ± 10.3	18	T2: 43	32 (2-125)
					ORR (PSM)	43	65.4 ± 7.6	15	T2: 43
Regmi et al[40]	2020	China	Retrospective	7	LRR	20	> 70y: 4	13	T1b: 10; T2: 10	21.28 (12-29)
					ORR	30	> 70y: 3	19	T1b: 13; T2: 17	20.4 (12.25-29.50)
Huang et al[44]	2022	China	Retrospective	8	LRR (PSM)	35	58.7 ± 10.5	19	T3: 35	NA
					ORR (PSM)	35	60.4 ± 10.6	18	T3: 35	NA
D'Silva et al[45]	2021	China	Retrospective	7	LRR (PSM)	12	68.5 ± 10.56	7	T2: 7;T3: 9	21.5 (9-80)
					ORR (PSM)	12	67.5 ± 12.88	7	T2: 5;T3: 3
Lee et al[42]	2022	Korea	Retrospective	8	LRR (PSM)	56	62.0 ± 13.7	27	T2: 56	26.2
					ORR (PSM)	56	62.5 ± 15.0	28	T2: 56
Wang et al[39]	2020	China	Retrospective	8	LRR	45	62.6 (45-76)	29	Tb: 30; T2: 15	38 (3-84)
					ORR	61	65.2 (51-82)	37	Tb: 35;T2: 26	33 (6-72)
AlMasri et al[49]	2020	United States	Retrospective	8	LRR	235	66.1 ± 11.8	64	I: 24; II: 78; III: 133	NA
					ORR	445	65.8 ± 11.2	294	I: 29; II: 114; III: 302	NA
Cho et al[47]	2022	Korea	Retrospective	7	LRR (PSM)	19	69.9 ± 9.1	11	T2: 19	26
					ORR (PSM)	19	66.7 ± 7.8	7	T2: 19	70

UKN: Unknown; LRR: Laparoscopic radical resection; ORR: Open radical resection; PSM: Propensity score matching; NOS: The modified Newcastle–Ottawa scale; TNM: Tumor-node-metastasis; NA: Not available; F: Female; M: Male; CI: Confidence interval.

Table 3 Perioperative outcomes of included comparative studies

Ref.	Group	Pts	No. LNH	R0 margin(n)	Operation time (min)	Blood loss (mL)	POLS	Complications	Complications(Clavien-Dindo 3-4)
Agarwal et al[32]	LRR	24	12.5 ± 5.4	NA	270 (180-340)	200 (100-850)	5 (3-16)	3	NA
	ORR	46	12.9 ± 5.4	NA	240 (180-360)	275 (100-800)	5 (3-17)	8	NA
Feng et al[33]	LRR	41	5 ± 3	33	137 ± 92	358 ± 390	5 ± 3	3	NA
	ORR	61	5 ± 3	47	168 ± 51	386 ± 391	11 ± 5	6	NA
Itano et al[34]	LRR	16	12.6 ± 3.1	NA	368 ± 73	152 ± 90	9.1 ± 1.6	1	NA
	ORR	14	10.2 ± 4.0	NA	352 ± 75	777 ± 392	21.6 ± 9.0	3	NA
Jang et al[35]	LRR	55	7.6 ± 3.4	NA	231.0 ± 95.2	225.1 ± 328.6	5.8 ± 5.3	7	4
	ORR	44	9.9 ± 6.8	NA	252.5 ± 76.1	310.5 ± 260.9	9.5 ± 4.8	6	3
Nag et al[36]	LRR	30	11.9 ± 5.2	30	286.5 ± 71.6	158.6 ± 85.7	6.4 ± 3.1	5	0
	ORR	38	12.7 ± 4.2	37	274.2 ± 96.3	219.4 ± 87.7	9 ± 8.0	12	5
Ong et al[37]	LRR	623	NA	484	NA	NA	NA	NA	NA
	ORR	882	NA	664	NA	NA	NA	NA	NA
Vega et al[38]	LRR	65	6 (0-19)	62	240 (120-275)	300 (30-1200)	4 (2-18)	12	NA
	ORR	190	6 (0-27)	172	240 (60-600)	200 (50-2000)	6 (1-52)	38	NA
Cao et al[46]	LRR	53	6 (1-16)	NA	238.4	257 ± 6.3	10.4 ± 18.6	NA	NA
	ORR	61	8 (1-42)	NA	215.7	256.2 ± 6.3	11.3 ± 18.6	NA	NA
Dou et al[48]	LRR (PSM)	30	10.12 ± 0.90	NA	328.12 ± 21.53	256.74 ± 39.21	10.43 ± 0.97	6	3
	ORR (PSM)	30	7.92 ± 0.57	NA	245.82 ± 15.18	484.36 ± 64.67	14.23 ± 1.07	4	2
Lee et al[43]	LRR	20	5.75 ± 3.54	19	186.60 ± 88.14	320.00 ± 451.72	10.95 ± 4.82	2	2
	ORR	24	6.75 ± 4.17	23	231.67 ± 82.97	593.75 ± 912.04	12.80 ± 4.87	5	5
Navarro et al[41]	LRR (PSM)	43	6.12 ± 5.78	NA	139.05 ± 97.09	71.63 ± 178.77	6.05 ± 9.846	0	0
	ORR(PSM)	43	11.93 ± 7.03	NA	211.16 ± 91.36	208.14 ± 242.165	12.58 ± 5.504	4	0
Regmi et al[40]	LRR	20	5.4 ± 3.5	20	258.25 ± 72.50	242 ± 108.5	6.2 ± 2.4	3	NA
	ORR	30	5.8 ± 2.1	30	227.00 ± 59.81	401 ± 130.3	8.6 ± 2.3	6	NA
Huang et al[44]	LRR (PSM)	35	8.4 ± 4.6	34	245.0 (183.0-285.0)	50.0 (50.0-150.0)	6.0 (6.0-7.0)	4	1
	ORR (PSM)	35	8.1 ± 3.9	33	160.0 (125.0-230.0)	50.0 (50.0-150.0)	7.0 (6.0-8.0)	6	2
Silva et al[45]	LRR (PSM)	12	6.5 (4-9.5)	NA	237.5 (120-520)	300 (150-1750)	4.5 (2-12)	1	0
	ORR (PSM)	12	8.5 (4.5-14.5)	NA	272.5 (180-560)	275 (100-1800)	8 (5-32)	4	0
Lee et al[42]	LRR (PSM)	56	4.6 ± 4.1	NA	171.7 ± 64.1	NA	5.7 ± 4.2	4	NA
	ORR (PSM)	56	6.9 ± 4.9	NA	98.0 ± 53.2	NA	9.8 ± 4.9	7	NA
Wang et al[39]	LRR	45	19.8 ± 7.9	NA	115 ± 32.5	100 ± 25.4	3.5 ± 1.9	3	NA
	ORR	61	17.3 ± 5.7	NA	100 ± 20.4	200 ± 45.6	5.6 ± 2.7	8	NA
AlMasri et al[49]	LRR	235	6.5 ± 14.6	195	NA	NA	7.0 ± 13.0	NA	NA
	ORR	445	6.7 ± 13.5	348	NA	NA	8.8 ± 10.9	NA	NA
Cho et al[47]	LRR (PSM)	19	5.3 ± 6.6	NA	218.9 ± 145.0	NA	8.4 ± 5.9	4	0
	ORR (PSM)	19	7.3 ± 5.5	NA	316.8 ± 80.3	NA	14.4 ± 6.0	2	0

Pts: Patients; No. LNH: Number of lymph node harvested; LRR: Laparoscopic radical resection; ORR: Open radical resection; POLS: Postoperative length of stay; NA: Not available; PSM: Propensity score matching.