Unexpected Gallbladder Cancer With Cholecystectomy:A Meta-Analysis

Objectives:Aims to systematically assess and analyze the unexpected gallbladder cancer by Meta-analyze.Methods:Foreign databases include PubMed,EMBASE and Cochrane libraries.Chinese databases include CNKI,Wanfang Data and Weipu Date.1,240 published papers were included in the meta-analysis.After quality screening of the literature,Comprehensive Meta-Analysis vision 2 software was used for analysis.The epidemiological characteristics,the distribution of T-stages,and the sum of secondary operations for occasional gallbladder cancer were analyzed.The definition of accidental gallbladder cancer is that gallbladder cancer is not suspected before surgery,and gallbladder cancer is diagnosed pathologically during or after cholecystectomy.Results:The final summary population included 844 patients with unexpected gallbladder cancer.Preoperative diagnosis was found to be benign gallbladder disease.The unexpected gallbladder cancer during or after cholecystectomy was 0.322%(95%Cl:0.003-0.010).The unexpected gallbladder cancer of T2-stages was 44.6%(95%Cl:0.401-0.496).The frequency of T3 in unexpected gallbladder cancer was slightly higher than that in T1,with a combined ratio of 29.8%(95%CI:0.236-0.317)and 16.1%(95%Cl:0.135-0.187).TThe total rate of radical surgery for unexpected gallbladder cancer was 47.3%(95%Cl:0.396-0.494).The proportion of patients who could not undergo radical surgery in the second operation was 17.5%(95%Cl:0.118-0.209).Conclusions:1.The unexptected gallbladder cancer is not uncommon.We should be alert to the occurrence of unexpected gallbladder cancer,espeCIally for older women over the age of 60 and with chronic cholecystitis;2.Unexpected gallbladder cancer is mainly T2 and T3 stages,and radical cholecystectomy is required for T2 and later gallbladder cancer;3.Considering that the proportion of unresectable cancer is relatively high when the second surgery is attempted,further preoperative assessments are required before surgery for those who are considering reoperation and have longer intervals;4.Adenocarcinoma accounts for about 90.3%in unexpected gallbladder cancers.It is the same as the incidence of adenocarcinoma consistenting in gallbladder cancer;5.The secondary surgical treatment of stump resection is still necessary for evidence-based medicine6.The timing of secondary surgery for unexpected gallbladder cancer and the factors that lead to widespread metastases still require RCT researches of large centers;7.Patients with unexpected gallbladder cancer are more likely to choose less aggressive surgery,and they are reluctant to undergo extended radical surgery.