Early-Stage Gallbladder Cancer in the Surveillance, Epidemiology, and End Results Database: Effect of Extended Surgical Resection

• Published in: Archives of surgery (Chicago. 1960) Vol. 146; no. 6; pp. 734 - 738
• Main Authors: Downing, Stephanie R, Cadogan, Kerry-Ann, Ortega, Gezzer, Oyetunji, Tolulope A, Siram, Suryanarayana M, Chang, David C, Ahuja, Nita, Leffall, LaSalle D, Frederick, Wayne A. I
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.06.2011
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cholecystectomy; Epidemiology; Female; Gallbladder; Gallbladder Neoplasms - mortality; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Liver cancer; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lymph Node Excision; Male; Medical sciences; Middle Aged; Oncology; Patients; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; SEER Program; Survival analysis; Survival Rate; Tumors; Bile duct cancer; Surgical resection; Early stage; Malignant tumor; Biliary tract disease; Epidemiology; Gallbladder cancer; Result; Medicine; Gall bladder cancer; Treatment; Surveillance; Surgery; Database; Digestive diseases; Public health; Cancer
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.2011.128

HYPOTHESIS Extended surgical resection (ESR) may improve survival in patients with early-stage primary gallbladder cancer. DESIGN Retrospective analysis of findings in the Surveillance, Epidemiology, and End Results (SEER) database. SETTING Academic research. PATIENTS Individuals with potentially surgically curable gallbladder cancer (Tis, T1, or T2) who underwent a surgical procedure. MAIN OUTCOME MEASURES Overall survival, number of lymph nodes (LNs) excised, and results of simple cholecystectomy vs ESR. RESULTS We identified 3209 patients with early-stage gallbladder cancer (11.7% Tis, 30.1% T1, and 58.2% T2). On multivariate analysis, decreased survival was noted among patients older than 60 years (hazard ratio, 1.57; 95% confidence interval, 1.30-1.90), among patients with more advanced cancer (1.99; 1.46-2.70 for T1; 3.29; 2.45-4.43 for T2), and among patients with disease-positive LNs (1.65; 1.39-1.95 for regional; 2.58; 1.54-4.34 for distant) (P < .001 for all), while increased survival was observed among female patients (0.82; 0.70-0.96; P = .02) and among patients undergoing ESR (0.59; 0.45-0.78; P < .001). The survival advantage of ESR was seen only in patients with T2 lesions (0.49; 0.35-0.68; P < .001). Lymph node excision data were available for a subset of 2507 patients, of whom 68.2% had no LN excised, 28.2% had 1 to 4 LNs excised, and 3.6% had 5 or more LNs excised. On multivariate analysis, patients with 1 to 4 LNs excised had a survival benefit over those with no LN excised (HR, 0.55; 95% CI, 0.46-0.66; P < .001), and patients with 5 or more LNs excised had a survival benefit over patients with 1 to 4 LNs removed (0.63; 0.40-0.96; P = .03). Lymph node excision improved survival in patients with T2 lesions (0.42; 0.33-0.53; P < .001 for patients with 1-4 LNs excised). CONCLUSION Extended surgical resection, LN excision, or both may improve survival in certain patients with incidentally discovered gallbladder cancer.Arch Surg. 2011;146(6):734-738-->