Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2020; 8(6): 1074-1086
Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1074
Laparoscopic surgery for early gallbladder carcinoma: A systematic review and meta-analysis
Xu Feng, Jia-Sheng Cao, Ming-Yu Chen, Bin Zhang, Sarun Juengpanich, Jia-Hao Hu, Win Topatana, Shi-Jie Li, Ji-Liang Shen, Guang-Yuan Xiao, Xiu-Jun Cai, Hong Yu
Xu Feng, Jia-Sheng Cao, Ming-Yu Chen, Bin Zhang, Sarun Juengpanich, Jia-Hao Hu, Win Topatana, Shi-Jie Li, Ji-Liang Shen, Xiu-Jun Cai, Hong Yu, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Guang-Yuan Xiao, Department of General Surgery, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, Zhejiang Province, China
Author contributions: Feng X, Cao JS, Chen MY, Zhang B, Cai XJ, and Yu H designed the study and collected the data; Juengpanich S, Hu JH, Topatana W, and Li SJ analyzed the data; all authors performed the study and wrote the paper.
Supported by the Zhejiang Medical Health Science and Technology Project, No. 2016133597 and No. 2019321842; and Natural Science Foundation of Zhejiang Province, No. LQ18H160003.
Conflict-of-interest statement: The authors deny any conflict of interest.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong Yu, FACS, MD, PhD, Doctor, Surgeon, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. 3195016@zju.edu.cn
Received: December 29, 2019
Peer-review started: December 29, 2019
First decision: January 19, 2020
Revised: February 14, 2020
Accepted: February 28, 2020
Article in press: February 28, 2020
Published online: March 26, 2020
Abstract
BACKGROUND

There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC). We hypothesized that the laparoscopic approach is an alternative for early GBC.

AIM

To identify and evaluate the safety and feasibility of laparoscopic surgery in the treatment of early GBC.

METHODS

A comprehensive search of online databases, including MEDLINE (PubMed), Cochrane libraries, and Web of Science, was performed to identify non-comparative studies reporting the outcomes of laparoscopic surgery and comparative studies involving laparoscopic surgery and open surgery in early GBC from January 2009 to October 2019. A fixed-effects meta-analysis was performed for 1- and 5-year overall survival and postoperative complications, while 3-year overall survival, operation time, blood loss, the number of lymph node dissected, and postoperative hospital stay were analyzed by random-effects models.

RESULTS

The review identified 7 comparative studies and 8 non-comparative studies. 1068 patients (laparoscopic surgery: 613; open surgery: 455) were included in the meta-analysis of 1-, 3-, and 5-year overall survival with no significant differences observed [(HR = 0.54; 95%CI: 0.29-1.00; I2 = 0.0%; P = 0.051), (HR = 0.75; 95%CI: 0.34-1.65; I2 = 60.7%; P = 0.474), (HR = 0.71; 95%CI: 0.47-1.08; I2 = 49.6%; P = 0.107), respectively]. There were no significant differences in operation time [weighted mean difference (WMD) = 18.69; 95%CI: −19.98-57.36; I2 = 81.4%; P = 0.343], intraoperative blood loss (WMD = −169.14; 95%CI: −377.86-39.57; I2 = 89.5%; P = 0.112), the number of lymph nodes resected (WMD = 0.12; 95%CI: −2.95-3.18; I2 = 73.4%; P = 0.940), and the complication rate (OR = 0.69; 95%CI: 0.30-1.58; I2 = 0.0%; P = 0.377 ) between the two groups, while patients who underwent laparoscopic surgery had a reduced length of hospital stay (WMD = −5.09; 95%CI: −8.74- −1.45; I2 = 91.0%; P= 0.006).

CONCLUSION

This systematic review and meta-analysis confirms that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable survival and operation-related outcomes for early GBC.

Keywords: Laparoscopic surgery, Open surgery, Early gallbladder carcinoma, Survival, Meta-analysis

Core tip: Several studies have compared the safety and feasibility of laparoscopic surgery and open surgery for early gallbladder carcinoma. This systematic review and meta-analysis, included 7 comparative studies and 8 non-comparative studies, and found that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable 1-, 3-, and 5-year survival and operation-related outcomes for early gallbladder carcinoma. However, more prospective studies should be performed due to the limited sample size and lack of recurrence data.