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Undertreatment of Gallbladder Cancer: A Nationwide Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Gallbladder cancer has a high mortality rate and an increasing incidence. The current National Comprehensive Cancer Network (NCCN) guidelines recommend resection for all T1b and higher-stage cancers. This study aimed to evaluate re-resection rates and the associated survival impact for patients with gallbladder cancer.

Methods

Patients with gallbladder adenocarcinoma who underwent resection were identified from the National Cancer Database (2004–2015). Re-resection was defined as definitive surgery within 180 days after the first operation. Propensity scores were created for the odds of a patient having a re-resection. Patients were matched 1:2. Survival analyses were performed using the Kaplan–Meier and Cox proportional hazard methods.

Results

The study identified 6175 patients, and 466 of these patients (7.6%) underwent re-resection. Re-resection was associated with younger median age (65 vs 72 years; p < 0.0001), private insurance (41.6% vs 27.1%; p < 0.0001), academic centers (50.4% vs 29.7%; p < 0.0001), and treatment location in the Northeast (22.8% vs 20.4%; p = 0.0011). Compared with no re-resection, re-resection was associated with pT stage (pT2: 47.6% vs 42.8%; p = 0.0139) and pN stage (pN1-2: 28.1% vs 20.7%; p < 0.0001), negative margins on final pathology (90.1% vs 72.6%; p < 0.0001), and receipt of chemotherapy (53.7% vs 35.8%; p < 0.0001). The patients who underwent re-resection demonstrated significantly longer overall survival (OS) than the patients who did not undergo re-resection (median OS, 44.0 vs 23.0 months; p < 0.0001). After propensity score-matching, re-resection remained associated with superior survival (median OS, 44.0 vs 31.0 months; p = 0.0004).

Conclusions

Re-resection for gallbladder cancer is associated with improved survival but remains underused, particularly for early-stage disease.

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Authors and Affiliations

  1. Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Marianna V. Papageorge MD, Susanna W. L. de Geus MD, PhD, Alison P. Woods MD, Sing Chau Ng MS, Frederick T. Drake MD, MPH, Michael R. Cassidy MD, David B. McAneny MD, Jennifer F. Tseng MD, MPH & Teviah E. Sachs MD, MPH

  2. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alison P. Woods MD

Authors
  1. Marianna V. Papageorge MD
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  2. Susanna W. L. de Geus MD, PhD
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  3. Alison P. Woods MD
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  4. Sing Chau Ng MS
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  5. Frederick T. Drake MD, MPH
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  6. Michael R. Cassidy MD
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  7. David B. McAneny MD
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  8. Jennifer F. Tseng MD, MPH
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  9. Teviah E. Sachs MD, MPH
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Correspondence to Teviah E. Sachs MD, MPH.

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Papageorge, M.V., de Geus, S.W.L., Woods, A.P. et al. Undertreatment of Gallbladder Cancer: A Nationwide Analysis. Ann Surg Oncol 28, 2949–2957 (2021). https://doi.org/10.1245/s10434-021-09607-6

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  • DOI: https://doi.org/10.1245/s10434-021-09607-6

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