A 21‐year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate?

Abstract Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that...

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Published in:HPB (Oxford, England) England), 2013-01, Vol.15 (1), p.40-48
Main Authors: Hari, Danielle M, Howard, J. Harrison, Leung, Anna M, Chui, Connie G, Sim, Myung‐Shin, Bilchik, Anton J
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Carcinoma - mortality
Carcinoma - secondary
Carcinoma - surgery
Cholecystectomy - adverse effects
Cholecystectomy - mortality
Female
Gallbladder Neoplasms - mortality
Gallbladder Neoplasms - pathology
Gallbladder Neoplasms - surgery
Gastroenterology and Hepatology
Humans
Kaplan-Meier Estimate
Lymph Node Excision
Lymphatic Metastasis
Male
Medical research
Middle Aged
Multivariate Analysis
Neoplasm Staging
Original
Proportional Hazards Models
Radiotherapy, Adjuvant
Risk Factors
SEER Program
Surgery
Time Factors
Treatment Outcome
United States - epidemiology
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Summary:Abstract Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. Methods The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub‐stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log‐rank and Cox's regression analyses. Results Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow‐up of 22 months, 288 (25.8%) had died of GBC. Five‐year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively ( P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease‐specific survival ( P < 0.001), whereas radiation therapy portended worse survival ( P = 0.013). Conclusions In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered.
ISSN:1365-182X
1477-2574
DOI:10.1111/j.1477-2574.2012.00559.x