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The effect of preoperative jaundice in the surgical management of gallbladder carcinoma: An updated meta‐analysis
Author(s) -
Lv TianRun,
Hu HaiJie,
Regmi Parbatraj,
Liu Fei,
Li FuYu
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.17000
Subject(s) - medicine , jaundice , hepatectomy , cholecystectomy , cochrane library , gallbladder , meta analysis , carcinoma , bile duct , general surgery , surgery , resection
Abstract Background An updated meta‐analysis was performed on the significance of preoperative jaundice in the surgical management of gallbladder carcinoma (GBC). Methods A thorough database searching was performed in PubMed, EMBASE, and the Cochrane library for comparative studies between jaundiced and non‐jaundiced GBC patients. RevMan5.3 and Stata 13.0 software were used for statistical analysis. A total of nine measured outcomes were identified: resectability, R0 resection rate, concurrent bile duct resection, major hepatectomy, vital vascular reconstruction, combined adjacent organ resections, postoperative morbidities, mortalities, and overall survival (OS). Results A total of eight studies were finally included. Newcastle– Ottawa Quality Assessment Scale was used for evaluating the quality of all included studies and the details were recorded in Table S1. Our pooled results revealed that preoperative jaundice was associated with a significantly lower resectability ( p < 0.00001), a significantly lower R0 resection rate ( p < 0.00001), a significantly higher concurrent bile duct resection rate ( p < 0.00001), major hepatectomy rate (≥3 segments) ( p < 0.00001), and vital vascular reconstruction rate (portal vein or hepatic artery) ( p < 0.00001). Moreover, jaundiced patients experienced more postoperative morbidities ( p < 0.00001), mortalities ( p < 0.0001), and worse OS ( p < 0.00001). However, jaundice was not related to combined adjacent organ resections ( p = 0.58). Conclusion Preoperative jaundice in GBC patients seems to be contraindicated to curative resection and the optimal therapeutic strategies should be identified via multidisciplinary team rather than surgery alone. Candidates for curative surgery should be highly selected and experienced centers are preferred. More significant well‐designed studies are required for further exploration.