Outcomes following surgery versus non-surgical management for gallbladder cancer patients presenting with jaundice: A systematic review and meta-analysis.

Abstract

e16230 Background: Gallbladder cancer (GBC) presenting with obstructive jaundice typically indicates advanced disease and poor prognosis. There remains no consensus on whether surgical resection or non-surgical management offers superior outcomes. We conducted a systematic review and meta-analysis to compare survival, morbidity, mortality and quality of life in jaundiced GBC patients undergoing surgery versus non-surgical approaches. Methods: PubMed, Embase, Scopus, Google Scholar were searched for studies reporting outcomes in jaundiced GBC patients treated surgically or conservatively. Eligible studies included prospective or retrospective cohorts comparing overall survival, disease-free survival, perioperative mortality, and complications. Data were extracted by two reviewers, and pooled analyses were conducted using random-effects meta-analysis, calculating hazard ratios (HR) or risk ratios with 95% confidence intervals. Results: Six studies (five retrospective, one prospective) with 800 patients were included. Resectability in jaundiced GBC ranged from 27-62%. Surgical patients had significantly longer median survival (20 months) versus non-surgical patients (median 6 months). Pooled HR for mortality was 0.35 in favor of surgery. One-year survival with surgery was 40–70%, versus < 30% with non-surgical treatment. However, surgical morbidity exceeded 50% in some series, with perioperative mortality up to 7%. Notably, jaundice remained an adverse prognostic factor post-resection (HR 2.2). Conclusions: Surgery in selected jaundiced GBC patients confers a survival benefit over conservative management, though with high risks. Conservative treatment yields dismal outcomes. Given selection bias and lack of randomized trials, individualized decision-making and further research are warranted.