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Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta‐analysis
Author(s) -
Dasari Bobby V. M.,
Ionescu Mihnea I.,
Pawlik Timothy M.,
Hodson James,
Sutcliffe Robert P.,
Roberts Keith J.,
Muiesan Paolo,
Isaac John,
Marudanayagam Ravi,
Mirza Darius F.
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25186
Subject(s) - medicine , jaundice , contraindication , hazard ratio , odds ratio , gallbladder cancer , gallbladder , surgery , cholecystectomy , general surgery , cancer , confidence interval , alternative medicine , pathology
Introduction Preoperative jaundice is considered a relative contraindication to radical gallbladder cancer (GBC) resection due to poor prognosis and high postoperative morbidity. Recent reports have indicated that aggressive surgery may improve long‐term survival for patients with advanced GBC who present with obstructive jaundice. The current systematic review and meta‐analysis aimed to compare postoperative outcomes among jaundiced and non‐jaundiced patients with resectable GBC. Methods An electronic search was performed using several Medical Subject Headings terms: cholecyst, gallbladder, tumor, cancer, carcinoma, adenocarcinoma, neoplasia, neoplasm, jaundice, and icterus. Overall survival after surgery was the primary outcome; resectability and postoperative morbidity were the secondary outcomes. Results Overall survival was shorter among patients who presented with jaundice (Hazard ratio [HR]: 2.21, 95% confidence interval [CI], 1.64‐2.97; P < 0.001). Patients with jaundice were less likely to have resectable disease (odds ratio: 0.27, 95% CI, 0.17‐0.43; P < 0.001). The jaundice group had higher odds of postoperative morbidity, bile‐leak, and posthepatectomy failure versus the non‐jaundiced control group. Conclusions Radical surgery for GBC resection for patients presenting with obstructive jaundice was associated with reduced overall survival and increased postoperative morbidity. Jaundiced patients with advanced GBC should be considered for surgical resection but need careful evaluation and counseling before undertaking extensive surgical resection.