title: Routine extra-hepatic bile duct resection in gallbladder cancer patients without bile duct infiltration: A systematic review.
abstract: OBJECTIVE
  The optimal treatment for advanced gallbladder cancer, in particular T2 stage cancer, is unclear. The use of "radical cholecystectomy" or more extended procedures with extra-hepatic bile duct resection are matter of debate. Due to the lack of consensus regarding the oncological significance of routine extra-hepatic bile duct (EBD) resection for gallbladder carcinoma, we decided to perform a systematic review investigating the real benefit of this procedure focusing on the primary outcomes of overall survival and disease-free survival.
  
  
  METHODS
  A systematic literature search was performed using PubMed, EMBASE, Scopus and the Cochrane Library Central according to the PRISMA statement guidelines for conducting and reporting systematic reviews. Multiple primary and secondary outcomes were analyzed.
  
  
  RESULTS
  The selected articles included 424 patients who underwent routine EBD resection without bile duct infiltration. Only two papers discussed the number of dissected lymph nodes during EBD resection for gallbladder carcinoma. Four of the seven included papers reported on tumor involvement in lymph nodes at rates ranging between 39% and 83%. All of the studies included in this systematic review reported on results of overall survival. In general, 5-years OS rate of the EBD-resected patients was not significantly different than that of the EBD-preservation group, while the mobility was significantly higher in the EBD resection group.
  
  
  CONCLUSIONS
  Routine EBD resection in gallbladder cancer patients without bile duct infiltration is not associated with improved overall survival, improved lymph-node harvesting or with minor recurrence rate, but it is associated with higher morbidity rates.
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. Electronic address: giuseppe.nigri@uniroma1.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giammauro
authors.initials: G
authors.lastname: Berardi
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mattana
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Mangogna
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Petrucciani
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sagnotta
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Aurello
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Angelo
authors.affiliation: General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
mesh_terms: D002763:Cholecystectomy; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans
keywords: Extra-hepatic bile duct resection; Gallbladder cancer; Systematic review