Laparoscopic And Laparotomy Treatment For Gallbladder Cancer : A Meta-Analysis

Objective:Aims to compare the clinical efficacy of laparoscopy and laparotomy in the treatment of gallbladder cancer by Meta-Analysis,To provide a reference for the controversial views of clinical laparoscopy in the treatment of gallbladder cancer.Methods:The data of controlled clinical studies on laparoscopic and laparotomy for the treatment of gallbladder cancer,through computer retrieval,were collected from the Cochrane library,EMbase and PubMed(MEDLINE)databases,and the collected summary data were analyzed by Review Manager 5.3 software.Inclusion criteria for laparoscopic and open treatment of gallbladder cancer were :(1)the study design must be a controlled study evaluating laparoscopic and open treatment of gallbladder cancer;(2)at least one clinical outcome was compared;(3)it has to be human research.The differences between the two groups were described by OR,WMD and 95%CI.Results :Eleven retrospective controlled clinical studies involving 1455 patients were included.The results of meta-analysis indicated that the 5-year survival rate of laparoscopic treatment of gallbladder cancer was significantly higher than that of the laparotomy group [46.02%vs.38.04,OR = 1.70,95%,CI(1.29,2.24),P = 0.0002],although there was no statistically significant difference between laparoscopic and laparotomy in the treatment of recurrent and metastatic gallbladder cancer [38.59% vs.33.05%,OR = 0.85,95%,CI(0.64,1.12),P = 0.24].However,postoperative complications were significantly lower than those in the laparotomy group [8.55%vs.13.97%,OR = 0.54,95%,CI(0.32,0.89),P = 0.02].In the laparoscopic group,intraoperative blood loss [WMD =-248.89,95%,CI(-329.80,-167.97),P < 0.00001],postoperative hospital stay [WMD =-4.03,95%,CI(-4.41,-3.65),P < 0.00001] was significantly better than that in the laparotomy group.The operation time of the two groups [WMD =-33.25,95%,CI(-76.28,9.79),P = 0.13] was not statistically significant,but the number of lymph node acquisition during laparotomy [WMD =-0.69,95%,CI(-0.97,-0.41),P < 0.00001] was significantly better than that of the laparoscopic group.Conclusion:1.laparoscopy is safe and effective for the treatment of gallbladder cancer;2.At present,laparoscopic radical cholecystectomy is feasible for T1 stage gallbladder cancer patients,while laparoscopic surgery is feasible for T2-3stage patients in experienced hepatobiliary specialized centers.Whether laparoscopic surgery is feasible for T4 stage patients remains to be further studied by evidence-based medicine.3.The selection of surgical methods for patients with different TNM stages is still controversial and needs multi-center RCT study;...