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Effect of lymphadenectomy in curative gallbladder cancer treatment: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

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.

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Acknowledgements

This meta-analysis is based on a literature review which was Bernhard Widmann’s Master of Science in Public Health project report at the London School of Hygiene and Tropical Medicine. The author thanks his supervisor, the module coordinators, and the library staff at the London School of Hygiene and Tropical Medicine for their support. All authors thank Lydia Bird and Lydia Widmann for their help with the English language editing.

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  1. Ignazio Tarantino and Thomas Steffen contributed equally to this work.

Authors and Affiliations

  1. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland

    Bernhard Widmann, Rene Warschkow, Ulrich Beutner, Kristjan Ukegjini, Bruno M. Schmied, Ignazio Tarantino & Thomas Steffen

  2. Department of Surgery, Paracelsus Medical University, Salzburg, Austria

    Michael Weitzendorfer

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Contributions

Study conception and design: B.W., R.W., I.T., and T.S. Acquisition, analysis, or interpretation of data for the work: B.W., R.W., U.B., M.W., K.U., B.S., I.T., and T.S. Drafting the work and revising it critically: B.W., R.W., U.B., M.W., K.U., B.S., I.T., and T.S. Final approval of the version to be published: B.W., R.W., U.B., M.W., K.U., B.S., I.T., and T.S.

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Correspondence to Bernhard Widmann.

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Widmann, B., Warschkow, R., Beutner, U. et al. Effect of lymphadenectomy in curative gallbladder cancer treatment: a systematic review and meta-analysis. Langenbecks Arch Surg 405, 573–584 (2020). https://doi.org/10.1007/s00423-020-01878-z

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