The effect of preoperative jaundice in the surgical management of gallbladder carcinoma: An updated meta‐analysis

• Published in: ANZ journal of surgery Vol. 91; no. 7-8; pp. E455 - E464
• Main Authors: Lv, Tian‐Run, Hu, Hai‐Jie, Regmi, Parbatraj, Liu, Fei, Li, Fu‐Yu
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.07.2021; Blackwell Publishing Ltd
• Subjects: Bile ducts; Comparative studies; Database searching; Gallbladder; Gallbladder cancer; Hepatectomy; Hepatic artery; Jaundice; Meta-analysis; Patients; Portal vein; preoperative jaundice; prognosis; Quality assessment; Quality control; Statistical analysis; Surgery
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.17000

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. The current study was performed to systematically re‐evaluate the significance of preoperative jaundice in the surgical management of gallbladder carcinoma (GBC). The final synthetic results revealed that curative surgery seems to be contraindicated in GBC patients presenting with preoperative jaundice and that a significantly lower resectability rate, R0 resection rate, more extended resections, more morbidities, more mortalities, and worse survival were observed in the jaundiced group.