Abstract：
BACKGROUND: Biliary spillage (BS) is a common complication following initial cholecystectomy for gall bladder cancer (GBC). Few studies have explored the importance of BS as a long-term prognostic factor. We perform a meta-analysis of the association between BS and survival in GBC.
METHODS: A systematic literature search was performed in February 2023. Studies evaluating the incidence of BS and its association with long-term outcomes in patients undergoing initial laparoscopic or open cholecystectomy for either incidental or resectable GBC were included. Overall survival (OS), disease-free survival (DFS), and rate of peritoneal carcinomatosis (RPC) were the primary end points. Forest plot analyses were used to calculate the pooled hazard ratios (HRs) of OS, DFS, and RPC. Metaregression was used to evaluate study-level association between BS and perioperative risk factors.
RESULTS: Of 181 published articles, 11 met inclusion criteria with a sample size of 1116 patients. The rate of BS ranged between 9% and 67%. On pooled analysis, BS was associated with worse OS (HR = 1.68, 95% confidence interval [CI] = 1.32-2.14), DFS (pooled HR= 2.19, 95% CI = 1.30-3.68), and higher RPC (odds ratio = 9.37, 95% CI = 3.49-25.2). The rate of BS was not associated with higher T stage, lymph node metastasis, higher grade, positive margin status, reresection, or conversion rates.
CONCLUSIONS: Our meta-analysis shows that BS is a predictor of higher peritoneal recurrence and poor survival in GBC. BS was not associated with tumor characteristics or conversion rates. Further research is needed to identify other potential risk factors for BS and investigate the ideal treatment schedule to improve survival.
METHODS: A systematic literature search was performed in February 2023. Studies evaluating the incidence of BS and its association with long-term outcomes in patients undergoing initial laparoscopic or open cholecystectomy for either incidental or resectable GBC were included. Overall survival (OS), disease-free survival (DFS), and rate of peritoneal carcinomatosis (RPC) were the primary end points. Forest plot analyses were used to calculate the pooled hazard ratios (HRs) of OS, DFS, and RPC. Metaregression was used to evaluate study-level association between BS and perioperative risk factors.
RESULTS: Of 181 published articles, 11 met inclusion criteria with a sample size of 1116 patients. The rate of BS ranged between 9% and 67%. On pooled analysis, BS was associated with worse OS (HR = 1.68, 95% confidence interval [CI] = 1.32-2.14), DFS (pooled HR= 2.19, 95% CI = 1.30-3.68), and higher RPC (odds ratio = 9.37, 95% CI = 3.49-25.2). The rate of BS was not associated with higher T stage, lymph node metastasis, higher grade, positive margin status, reresection, or conversion rates.
CONCLUSIONS: Our meta-analysis shows that BS is a predictor of higher peritoneal recurrence and poor survival in GBC. BS was not associated with tumor characteristics or conversion rates. Further research is needed to identify other potential risk factors for BS and investigate the ideal treatment schedule to improve survival.
摘要：
背景：胆道溢出（BS）是胆囊癌（GBC）初次胆囊切除术后的常见并发症。很少有研究探讨BS作为长期预后因素的重要性。我们对BS与GBC生存率之间的关系进行了荟萃分析。
方法：于2023年2月进行了系统的文献检索。纳入了评估BS发生率及其与初次腹腔镜或开腹胆囊切除术患者长期预后的关系的研究。总生存期（OS），无病生存率（DFS），腹膜癌病（RPC）的发生率是主要终点。森林地块分析用于计算OS的合并风险比(HR)，DFS,和RPC。元回归用于评估BS与围手术期危险因素之间的研究水平关联。
结果：在已发表的181篇文章中，11例符合纳入标准，样本量为1116例。BS的发生率介于9%和67%之间。在汇总分析中，BS与OS较差相关（HR=1.68，95%置信区间[CI]=1.32-2.14），DFS（合并HR=2.19，95%CI=1.30-3.68），和更高的RPC（比值比=9.37，95%CI=3.49-25.2）。BS的发生率与较高的T分期无关，淋巴结转移,更高等级,正边距状态，再切除,或转化率。
结论：我们的荟萃分析显示，BS是GBC中腹膜复发率较高和生存率较差的预测因子。BS与肿瘤特征或转化率无关。需要进一步的研究来确定BS的其他潜在危险因素，并研究理想的治疗方案以提高生存率。
方法：于2023年2月进行了系统的文献检索。纳入了评估BS发生率及其与初次腹腔镜或开腹胆囊切除术患者长期预后的关系的研究。总生存期（OS），无病生存率（DFS），腹膜癌病（RPC）的发生率是主要终点。森林地块分析用于计算OS的合并风险比(HR)，DFS,和RPC。元回归用于评估BS与围手术期危险因素之间的研究水平关联。
结果：在已发表的181篇文章中，11例符合纳入标准，样本量为1116例。BS的发生率介于9%和67%之间。在汇总分析中，BS与OS较差相关（HR=1.68，95%置信区间[CI]=1.32-2.14），DFS（合并HR=2.19，95%CI=1.30-3.68），和更高的RPC（比值比=9.37，95%CI=3.49-25.2）。BS的发生率与较高的T分期无关，淋巴结转移,更高等级,正边距状态，再切除,或转化率。
结论：我们的荟萃分析显示，BS是GBC中腹膜复发率较高和生存率较差的预测因子。BS与肿瘤特征或转化率无关。需要进一步的研究来确定BS的其他潜在危险因素，并研究理想的治疗方案以提高生存率。
