PDF(Pubmed)
Abstract：
UNASSIGNED: Concerns over the security of laparoscopic radical operation for gallbladder cancer (GBC) persist. This systematic review and meta-analysis attempted to compare the safety and efficacy of laparoscopic surgery (LS) versus open surgery (OS) in the treatment of GBC.
UNASSIGNED: The PubMed, EMBASE, and Web of Science were searched from inception to July 18, 2022. Literature search, quality assessment, and data extraction were completed independently and in duplicate. Effect-size estimates expressed as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence interval (CI) were derived under the random-effects model.
UNASSIGNED: A total of 27 independent studies including 2,868 participants were meta-analyzed. Significance was noted for intraoperative blood loss (WMD: -117.194, 95% CI: -170.188 to 64.201, P<0.001), harvested lymph nodes (WMD: -1.023, 95% CI: -1.776 to -0.269, P=0.008), postoperative hospital stay (WMD: -3.555, 95% CI: -4.509 to -2.601, P<0.001), postoperative morbidity (OR: 0.596, 95% CI: 0.407 to 0.871, P=0.008), overall survival rate at 2-year (OR: 1.524, 95% CI: 1.143 to 2.031, P=0.004), T2 survival at 1-year (OR: 1.799, 95% CI: 1.777 to 2.749, P<0.01) and 2-year (OR: 2.026, 95% CI: 1.392 to 2.949, P<0.001), as well as T3 survival at 1-year (OR: 2.669, 95% CI: 1.564 to 4.555, P<0.001) and 2-year (OR: 2.300, 95% CI: 1.308 to 4.046, P=0.004). Subgroup analyses revealed that ethnicity, incidental GBC, sample size, and follow-up period were possible sources of heterogeneity. There was a low probability of publication bias for all outcomes except postoperative morbidity.
UNASSIGNED: Our findings indicated that LS statistically had better 2-year survival rates, less intraoperative bleeding, shorter hospitalization times, and lower rates of complications than OS. However, the superiority and even the safety of LS still remain an open question due to the impact of incidental GBC, unaccounted heterogeneity, publication bias, lymph node dissection, and port-site metastasis.
UNASSIGNED: The PubMed, EMBASE, and Web of Science were searched from inception to July 18, 2022. Literature search, quality assessment, and data extraction were completed independently and in duplicate. Effect-size estimates expressed as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence interval (CI) were derived under the random-effects model.
UNASSIGNED: A total of 27 independent studies including 2,868 participants were meta-analyzed. Significance was noted for intraoperative blood loss (WMD: -117.194, 95% CI: -170.188 to 64.201, P<0.001), harvested lymph nodes (WMD: -1.023, 95% CI: -1.776 to -0.269, P=0.008), postoperative hospital stay (WMD: -3.555, 95% CI: -4.509 to -2.601, P<0.001), postoperative morbidity (OR: 0.596, 95% CI: 0.407 to 0.871, P=0.008), overall survival rate at 2-year (OR: 1.524, 95% CI: 1.143 to 2.031, P=0.004), T2 survival at 1-year (OR: 1.799, 95% CI: 1.777 to 2.749, P<0.01) and 2-year (OR: 2.026, 95% CI: 1.392 to 2.949, P<0.001), as well as T3 survival at 1-year (OR: 2.669, 95% CI: 1.564 to 4.555, P<0.001) and 2-year (OR: 2.300, 95% CI: 1.308 to 4.046, P=0.004). Subgroup analyses revealed that ethnicity, incidental GBC, sample size, and follow-up period were possible sources of heterogeneity. There was a low probability of publication bias for all outcomes except postoperative morbidity.
UNASSIGNED: Our findings indicated that LS statistically had better 2-year survival rates, less intraoperative bleeding, shorter hospitalization times, and lower rates of complications than OS. However, the superiority and even the safety of LS still remain an open question due to the impact of incidental GBC, unaccounted heterogeneity, publication bias, lymph node dissection, and port-site metastasis.
摘要：
■对腹腔镜胆囊癌（GBC）根治术的安全性的担忧仍然存在。这项系统评价和荟萃分析试图比较腹腔镜手术（LS）与开腹手术（OS）治疗GBC的安全性和有效性。
■PubMed，EMBASE,和WebofScience从成立到2022年7月18日进行了搜索。文献检索,质量评估，和数据提取独立完成，一式两份。在随机效应模型下得出以加权平均差（WMD）或比值比（OR）表示的效应大小估计值，置信区间为95％（CI）。
■对包括2,868名参与者在内的27项独立研究进行了荟萃分析。术中失血量有显著性意义(WMD:-117.194,95%CI:-170.188至64.201,P<0.001),收集的淋巴结（WMD：-1.023，95％CI：-1.776至-0.269，P=0.008），术后住院时间（WMD：-3.555，95%CI：-4.509至-2.601，P<0.001），术后发病率(OR:0.596,95%CI:0.407~0.871,P=0.008),2年总生存率（OR：1.524，95％CI：1.143至2.031，P=0.004），T2生存率在1年（OR：1.799，95％CI：1.777至2.749，P<0.01）和2年（OR：2.026，95％CI：1.392至2.949，P<0.001），以及1年（OR：2.669，95％CI：1.564至4.555，P<0.001）和2年（OR：2.300，95％CI：1.308至4.046，P=0.004）的T3生存率。亚组分析显示，种族，附带GBC，样本量,和随访期是异质性的可能来源。除术后发病率外，所有结局的发表偏倚概率较低。
■我们的研究结果表明，从统计学上讲，LS具有更好的2年生存率，术中出血少，住院时间缩短,并发症发生率低于OS。然而,由于附带GBC的影响，LS的优越性甚至安全性仍然是一个悬而未决的问题，下落不明的异质性，出版偏见，淋巴结清扫术,和端口部位转移。
■PubMed，EMBASE,和WebofScience从成立到2022年7月18日进行了搜索。文献检索,质量评估，和数据提取独立完成，一式两份。在随机效应模型下得出以加权平均差（WMD）或比值比（OR）表示的效应大小估计值，置信区间为95％（CI）。
■对包括2,868名参与者在内的27项独立研究进行了荟萃分析。术中失血量有显著性意义(WMD:-117.194,95%CI:-170.188至64.201,P<0.001),收集的淋巴结（WMD：-1.023，95％CI：-1.776至-0.269，P=0.008），术后住院时间（WMD：-3.555，95%CI：-4.509至-2.601，P<0.001），术后发病率(OR:0.596,95%CI:0.407~0.871,P=0.008),2年总生存率（OR：1.524，95％CI：1.143至2.031，P=0.004），T2生存率在1年（OR：1.799，95％CI：1.777至2.749，P<0.01）和2年（OR：2.026，95％CI：1.392至2.949，P<0.001），以及1年（OR：2.669，95％CI：1.564至4.555，P<0.001）和2年（OR：2.300，95％CI：1.308至4.046，P=0.004）的T3生存率。亚组分析显示，种族，附带GBC，样本量,和随访期是异质性的可能来源。除术后发病率外，所有结局的发表偏倚概率较低。
■我们的研究结果表明，从统计学上讲，LS具有更好的2年生存率，术中出血少，住院时间缩短,并发症发生率低于OS。然而,由于附带GBC的影响，LS的优越性甚至安全性仍然是一个悬而未决的问题，下落不明的异质性，出版偏见，淋巴结清扫术,和端口部位转移。
