| ObjectiveGallbladder cancer is one of the most common malignant tumors in the biliary system.There are differences in the incidence of gallbladder cancer between regional,ethnic and gender.Surgical treatment is the only effective radical treatment at present.Complete and thorough resection of gallbladder cancer provides the only chance of cure and long-term survival for patients.For patients with early stage of gallbladder cancer,The 5-year survival rate can reach 95%-100%after simple cholecystectomy.It requires radical or extended radical resection of gallbladder cancer when reaching stage T2 or above.However,there is still much controversy about how to operate on stage T1b gallbladder cancer which tumors invading the gallbladder muscular layer.In view of this controversy,we collected relevant literature for meta-analysis.By comparing and analyzing the differences of 1-year,3-year and 5-year survival rates between the two surgical methods,we sought to evaluate the reasonable treatment of Nevin ? gallbladder cancer,and to provide evidence-based theoretical basis for the choice of clinical treatment.MethodsWe conducted a comprehensive search in the following sources,Wanfang database,Chinese Academic Journal Full-Text Database(CNKI),PubMed,Cochrane Library and Chinese Biomedical Literature Database,for all potential relevant articles published from the establishment of the database until December 2018 according to the inclusion and exclusion criteria previously formulated.In order to improve the recall rate,all relevant references were tracked manually.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of literature.Relevant data were extracted and the ratio(OR)was usually used to evaluate the efficacy of the two methods,and 95%confidence interval(CI)was used to represent the level of test effect.All the statistical analysis were performed with Revman 5.3 software,which was also used to draw forest maps.Publication bias was assessed by Funnel plot test.ResultsA total of 1298 patients with gallbladder cancer were included in 18 papers,of which 14 were related to one-year survival rate,of which 3 were related to one-year survival rate,and all the two groups survived;14 were related to three-year survival rate,and 17 were included in 5-year survival rate analysis.The results showed that:1.Fourteen studies analyzed the 1-year survival rate after simple cholecystectomy and radical cholecystectomy for gallbladder cancer.The pooled OR was equal to 0.20(95%CI,0.12-0.32)and P value was less than 0.00001.There are differences in the statistical significance.95%CI did not include 1,and pooled with OR was less than 1,which suggestde that the 1-year survival rate of patients with simple cholecystectomy was lower than with radical cholecystectomy.Sensitivity analysis of replacement effect model showed that OR was 0.21,and 95%CI was(0.13,0.34).There was no difference between the two,which means the statistical results was stable.The results suggested that there was little publication bias for the studies included.2.Fourteen studies were included for the the 3-year survival rate after cholecystectomy and radical cholecystectomy.The results of heterogeneity test showed that the heterogeneity of the results was low.Fixed-effect model was used to analyze the combined effect of the index and draw funnel plot.The pooled OR was 0.33(95%CI,0.22-0.50)and P was less than 0.00001.95%CI did not include 1.OR<1 means the 3-year survival rate was lower in the patients with simple cholecystectomy than with radical cholecystectomy.Sensitivity analysis of replacement effect model showed that OR=0.33,95%CI was(0.22,0.51).There was little difference between the two values,which indicates that the statistical results were stable and there was little publication bias of the studies included.3.Seventeen studies involving 5-year survival after cholecystectomy and radical cholecystectomy for gallbladder cancer were included.Heterogeneity test was performed first.The results showed that the heterogeneity among the studies was low.Fixed-effect model was used to analyze the combined effect of the index and draw funnel charts.The combined OR=0.47,95%CI was(0.36,0.62),P<0.00001.95%CI does not contain 1,and combined with OR<1,suggesting that the 5-year survival rate of patients with simple cholecystectomy is lower than that of patients with radical cholecystectomy.Sensitivity analysis of the replacement effect model was performed.The results showed that OR=0.36,95%CI(0.21,0.61).There was little change between the two values,indicating that the statistical results were stable.The results suggest that the publication bias of the included studies is small.ConclusionThe survival rate is better after radical resection than after simple cholecystectomy in the patients who had Nevin ? gallbladder cancer. |
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