Effect of lymphadenectomy in curative gallbladder cancer treatment: a systematic review and meta-analysis
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SYSTEMATIC REVIEWS AND META-ANALYSES
Effect of lymphadenectomy in curative gallbladder cancer treatment: a systematic review and meta-analysis Bernhard Widmann 1 & Rene Warschkow 1 & Ulrich Beutner 1 & Michael Weitzendorfer 2 & Kristjan Ukegjini 1 & Bruno M. Schmied 1 & Ignazio Tarantino 1 & Thomas Steffen 1 Received: 9 January 2020 / Accepted: 31 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Only a small fraction of resectable gallbladder cancer (GBC) patients receive a thorough lymphadenectomy. The aim of this systematic review and meta-analysis was to investigate the effect of lymphadenectomy on survival in GBC surgery. Methods On May 19, 2019, MEDLINE, EMBASE, and the Cochrane Library were searched for English or German articles published since 2002. Studies assessing the effect of lymphadenectomy on survival in GBC surgery were included. Fixed effect and random effects models were used to summarise the hazard ratio (HR). Results Of the 530 identified articles, 18 observational studies (27,570 patients, 10 population-based, 8 cohort studies) were reviewed. In the meta-analysis, lymphadenectomy did not show a significant benefit for T1a tumours (n = 495; HR, 1.37; 95%CI, 0.65–2.86; P = 0.41). Lymphadenectomy showed a significant survival benefit in T1b (n = 1618; HR, 0.69; 95%CI, 0.50–0.94; P = 0.02) and T2 (n = 6204; HR, 0.68; 95%CI, 0.56–0.83; P < 0.01) tumours. Lymphadenectomy improved survival in the 2 studies assessing T3 tumours (n = 1961). A conclusive analysis was not possible for T4 tumours due to a low case load. Among patients undergoing lymphadenectomy, improved survival was observed in patients with a higher number of resected lymph nodes (HR, 0.57; 95%CI, 0.45–0.71; P < 0.01). Conclusions Regional lymphadenectomy improves survival in T1b to T3 GBC. A minimum of 6 retrieved lymph nodes are necessary for adequate staging, indicating a thorough lymphadenectomy. Patients with T1a tumours should be evaluated for lymphadenectomy, especially if lymph node metastases are suspected. Keywords Gallbladder neoplasms . Gallbladder cancer . Lymph node excision . Lymphadenectomy . Survival
Introduction With an incidence of 2.2/100,000, gallbladder cancer (GBC) is the sixth most common gastrointestinal cancer and the most common biliary tract malignancy [1, 2]. Despite improved cancer Ignazio Tarantino and Thomas Steffen contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01878-z) contains supplementary material, which is available to authorized users. * Bernhard Widmann [email protected] 1
Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland
2
Department of Surgery, Paracelsus Medical University, Salzburg, Austria
management over the past decade, GBC has a dismal prognosis. All stages included the 5-year survival rate improved from 5% in 1975 to 13% in 2005 [2]. The 5-year
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