Abstract
Background
Radical resection is recommended for selected patients with gallbladder (GB) cancer. We sought to determine whether radical resection improves survival for patients with early-stage cancer and to evaluate surgeon compliance with current treatment recommendations.
Patients and methods
Patients with stage 0, I, or II GB cancer who underwent surgical resection were identified from the Surveillance, Epidemiology, and End Results (SEER) tumor registry from 1988 through 2004. Patients were classified by surgical procedure performed (simple vs. radical resection) and adjuvant treatment given (radiation therapy [RT] vs. no RT). Unadjusted and adjusted overall survival (OS) and cancer-specific survival (CSS) were compared.
Results
Of the 4,631 patients who underwent surgery for early-stage GB cancer from 1988 through 2004, 4,188 (90.4%) underwent cholecystectomy alone and 443 (9.6%) underwent radical surgery including hepatic resection. The proportion of patients having radical surgery for T1b, T2, and T3 cancers was 4.5%, 5.6%, and 16.3%, respectively. For patients with T1b/T2 cancer, radical resection was associated with significant improvement in adjusted CSS (p = 0.01) and OS (p = 0.03). For patients with T3 cancers, we noted no improvement in CSS or OS. Survival for patients with node-positive disease (stage 2b) was universally poor and not improved by radical resection. For all patients who underwent radical resection, node negativity, female sex, age <70, low grade, and RT predicted improved CSS and OS.
Conclusions
Despite a significant survival advantage for patients with T1b/T2 GB cancer who undergo radical resection, this treatment is significantly underutilized. Ensuring delivery of recommended surgical treatment is vital to improving outcomes for patients with this disease.
Similar content being viewed by others
References
Surveillance Epidemiology, End Results (SEER) Program. (http://www.seer.cancer.gov) Limited-Use Data (1973–2004), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007, based on the November 2006 submission.
Benson AB, 3rd, Bekaii-Saab T, Ben-Josef E, et al. Hepatobiliary cancers. Clinical practice guidelines in oncology. J Natl Compr Netw 2006; 4(8):728-50.
Fong Y, Malhotra S. Gallbladder cancer: recent advances and current guidelines for surgical therapy. Adv Surg 2001;35:1–20.
Shih SP, Schulick RD, Cameron JL, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2007;245(6):893–901. doi:10.1097/SLA.0b013e31806beec2.
Foster JM, Hoshi H, Gibbs JF, et al. Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol 2007;14(2):833–840. doi:10.1245/s10434-006-9097-6.
Reddy SK, Marroquin CE, Kuo PC, et al. Extended hepatic resection for gallbladder cancer. Am J Surg 2007;194(3):355–361. doi:10.1016/j.amjsurg.2007.02.013.
Chan SY, Poon RT, Lo CM, et al. Management of carcinoma of the gallbladder: a single-institution experience in 16 years. J Surg Oncol 2008;97(2):156–164. doi:10.1002/jso.20885.
Wright BE, Lee CC, Iddings DM, et al. Management of T2 gallbladder cancer: are practice patterns consistent with national recommendations? Am J Surg 2007;194(6):820–825. discussion 825–6. doi:10.1016/j.amjsurg.2007.08.032.
Wise PE, Shi YY, Washington MK, et al. Radical resection improves survival for patients with pT2 gallbladder carcinoma. Am Surg. 2001;67(11):1041–1047.
Chijiiwa K, Kai M, Nagano M, et al. Outcome of radical surgery for stage IV gallbladder carcinoma. J Hepatobiliary Pancreat Surg 2007;14(4):345–350. doi:10.1007/s00534-006-1186-1.
Kai M, Chijiiwa K, Ohuchida J, et al. A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg 2007;11(8):1025–1032. doi:10.1007/s11605-007-0181-4.
Mojica P, Smith D, Ellenhorn J. Adjuvant radiation therapy is associated with improved survival for gallbladder carcinoma with regional metastatic disease. J Surg Oncol 2007;96(1):8–13. doi:10.1002/jso.20831.
Kresl JJ, Schild SE, Henning GT, et al. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma. Int J Radiat Oncol Biol Phys 2002;52(1):167–175. doi:10.1016/S0360-3016(01)01764-3.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jensen, E.H., Abraham, A., Habermann, E.B. et al. A Critical Analysis of the Surgical Management of Early-Stage Gallbladder Cancer in the United States. J Gastrointest Surg 13, 722–727 (2009). https://doi.org/10.1007/s11605-008-0772-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-008-0772-8