Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Asian J Surg. 2021 Dec;44(12):1493-1502. doi: 10.1016/j.asjsur.2021.03.015. Epub 2021 Apr 22.
Previous studies have explored the role of laparoscopic surgery (LS) in the surgical management of gallbladder carcinoma (GBC) and obtained satisfactory outcomes versus conventional open surgery. However, most of them either included a small number of patients or mainly focused on the early-staged lesions. Therefore, their results were less statistical powerful and a more comprehensive evaluation on the role of LS in GBC is warranted. A thorough database searching was performed in PubMed, EMBASE and Cochrane Library for comparative studies between the laparoscopic and open approach in the surgical management of GBC and 18 comparative studies were finally identified. RevMan 5.3 and Stata 13.0 software were used for statistical analyses. Pooled results revealed that patients in the laparoscopic group recovered faster with less intraoperative hemorrhage and less postoperative morbidity. Comparable operative time, overall recurrence rate, R0 resection rate, lymph node yield, intraoperative gallbladder violation rate and postoperative survival outcomes were also acquired. Regarding the debating issue of port-site recurrence, a significantly higher incidence of port-site recurrence was observed in laparoscopic group. However, having excluded studies on incidental gallbladder carcinoma, the subsequent pooled result showed no significant difference. Considering the inherent inconsistency of the surgical indication between laparoscopic and open surgeries and the deficiency of advanced lesions, we drew a conclusion that laparoscopic surgery seems to be only safe and feasible for early- or middle-staged lesions. Upcoming random controlled trials or comparative studies with equivalent surgical indication focused on advanced lesions are warranted for further evaluation.
先前的研究已经探讨了腹腔镜手术（LS）在胆囊癌（GBC）手术治疗中的作用，并与传统的开放性手术相比取得了令人满意的结果。然而，其中大多数研究要么纳入的患者数量较少，要么主要集中在早期病变。因此，它们的结果在统计学上的说服力较弱，需要更全面地评估 LS 在 GBC 中的作用。我们在 PubMed、EMBASE 和 Cochrane Library 中进行了全面的数据库检索，以查找腹腔镜与开放性方法在 GBC 手术治疗中的比较研究，最终确定了 18 项比较研究。使用 RevMan 5.3 和 Stata 13.0 软件进行统计分析。汇总结果表明，腹腔镜组患者恢复更快，术中出血量更少，术后发病率更低。同时也获得了相似的手术时间、总复发率、R0 切除率、淋巴结产量、术中胆囊损伤率和术后生存结果。关于腹腔镜手术切口复发的争议问题，腹腔镜组的切口复发率明显更高。然而，排除偶然发现的胆囊癌研究后，随后的汇总结果显示无显著差异。考虑到腹腔镜和开放性手术的手术适应证存在固有差异，以及晚期病变的不足，我们得出结论，腹腔镜手术似乎仅对早期或中期病变安全且可行。需要进行更多的随机对照试验或具有等效手术适应证的比较研究，以进一步评估晚期病变。
