Publication

Abstract : Background: Carcinoma gall bladder is an aggressive malignancy with surgical resection being the only chance for cure. Majority of patients recur after surgery. Effective adjuvant therapy are required to provide long-term survival. Role of adjuvant chemotherapy is still under debate. Methods: A systematic search of PubMed, Embase and Cochrane databases was conducted. Overall survival and recurrence free survival were the outcomes. Randomised control trials and cohort studies were analysed separately. Survival data were pooled as Hazard ratio (HR). Depending on the heterogeneity, fixed effects or random effects models were used. Results: Systematic review of adjuvant chemotherapy studies included 5 randomized control trial, 5 registry based studies and 8 retrospective cohorts comprising of a total 14532 patients. Pooled analysis of data from randomized controlled trials (HR=1.05; 95% CI 0.62, 1.96) and retrospective cohort studies (HR=0.86; 95% CI 0.60, 1.24, I2= 74%) revealed no benefit of adjuvant chemotherapy. Similarly, adjuvant chemotherapy did not benefit recurrence-free survival (RFS) on analysis of randomized controlled trials and cohort studies. The pooled hazard ratio of RFS on analysis of randomized controlled trials was 1.05 (95% CI 0.71, 1.55) compared to 1.05 (95% CI 0.71, 1.55) on analysis of retrospective cohort studies. Analysis of overall survival of registry-based studies showed the benefit of adjuvant chemotherapy, HR=0.87 (95% CI 0.81, 0.92, I2=78%). Conclusion: The use of adjuvant chemotherapy in carcinoma gall bladder does not confer benefit compared to observation alone.