The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis

Abstract

Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66-5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1-8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57-1.01), (HR = 0.74, 95% CI = 0.49-1.12), and DFS (RR = 0.99, 95% CI = 0.88-1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary.

Keywords: Cholecystectomy; Extended cholecystectomy; Gall bladder cancer; Hepatectomy; Surgery.