title: Surgical treatment for gallbladder cancer - a systematic literature review.
abstract: OBJECTIVE
  To evaluate existing evidence regarding surgical treatments for gallbladder cancer in a Health Technology Assessment. A specific aim was to evaluate whether extended surgery regarding liver, lymph nodes, bile duct, and adjacent organs compared with cholecystectomy alone in the adult patient with gallbladder cancer in early and late stages implies improved survival.
  
  
  METHODS
  In April 2015 and updated in June 2016, a systematic literature search was conducted in PubMed, Embase, and the Cochrane Library. Two authors independently screened titles, abstracts, and full-text articles. The certainty of evidence was evaluated according to GRADE.
  
  
  RESULTS
  Forty-four observational studies (non-randomised, controlled studies) and seven case series were included. Radical resection, including liver and lymph node resection, compared with cholecystectomy alone showed significantly better survival for patients with stages T1b and above. All studies had serious study limitations and the certainty of evidence was very low (GRADE ⊕○○○). A survival benefit seen in patients with stage T1b or higher with lymph node resection, was most evident in stage T2, but the certainty of evidence was low (GRADE ⊕⊕○○). It is uncertain whether routine bile duct resections improve overall survival in patients with gallbladder cancer stage T2-T4 (GRADE ⊕○○○).
  
  
  CONCLUSIONS
  Data indicate that prognosis can be improved if liver resection and lymph node resection is performed in patients with tumour stage T1b or higher. There is no evidence supporting resection of the bile duct or adjacent organs if it is not necessary in order to achieve radicality.
authors.affiliation: a Department of Transplantation and Liver Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Sternby Eilard
authors.affiliation: b Department of Surgery , Ryhov Hospital , Jönköping , Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Lundgren
authors.affiliation: a Department of Transplantation and Liver Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Cahlin
authors.affiliation: c HTA-Centrum of Region Västra Götaland, Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Strandell
authors.affiliation: d Medical Library, Sahlgrenska University Hospital , Gothenburg , Sweden.
authors.forename: Therese
authors.initials: T
authors.lastname: Svanberg
authors.affiliation: e Department of Surgery , Institute of Clinical and Experimental Medicine, University Hospital of Linkoping , Linköping , Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Sandström
mesh_terms: D001652:Bile Ducts / Q000473:pathology* / Q000601:surgery; D002763:Cholecystectomy; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis
keywords: Bile duct resection; gallbladder cancer; liver resection; lymph node dissection; surgery