Abstract
Background and Purpose
Current treatment guidelines for gallbladder cancer range from simple cholecystectomy to regional hepatic resection. Treatment patterns for radical resection and adjuvant chemotherapy vary. We aim to determine if there is any disparity in treatment or difference in survival between academic versus community treatment centers.
Methods
The National Cancer Database (NCDB) was queried from 2004 to 2014 for gallbladder carcinoma. Cases were stratified into treatment sites as “Community Cancer Center” (CCC) or “Academic Cancer Center” (ACC). Propensity score matching was performed for patient demographics, TNM stage, resection type, and administration of adjuvant chemotherapy. The primary outcome included 30-day mortality, 90-day mortality, and overall survival.
Results
There are similar frequencies of radical versus simple resection and administration of adjuvant chemotherapy between ACC and CCC. When propensity-matched for resection type, cases treated at ACC have lower 30-day mortality (4.1% vs. 6.9%) and 90-day mortality (13.2% vs. 18.5%) and increased 5-year overall survival (26.2% vs. 22.4%) (p < 0.01). After propensity matching for adjuvant chemotherapy, cases at ACC have lower 30-day mortality (4.12% vs. 7.71%) and 90-day mortality (13.22% vs. 19.19%) and increased overall survival (13.6% vs. 11.0%) (p < 0.01).
Discussion and Conclusions
While treatment patterns for gallbladder cancer at ACC and CCC were similar, there was a decrease in 30-day and 90-day mortality and improved overall survival associated with patients treated at ACC. Treatment site may have an impact in the surgical outcomes of gallbladder cancer patients. This disparity warrants further research.
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Contributions
Dr. Melillo and Dr. Hong conceived of the presented idea.
Drs. Gaughan, Melillo, and Linden performed the computations and verified the analytical methods.
Dr. Spitz and Dr. Atabek encouraged Dr. Melillo to revise her coding assignments and reviewed the subsequent data.
All authors discussed the results and contributed to the editing of the final manuscript.
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Plenary session presentation at the 60th Annual Meeting of Society of Surgery for Alimentary Tract in San Diego, California, May 17–21
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Melillo, A., Linden, K., Spitz, F. et al. Disparities in Treatment for Gallbladder Carcinoma: Does Treatment Site Matter?. J Gastrointest Surg 24, 1071–1076 (2020). https://doi.org/10.1007/s11605-019-04389-5
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DOI: https://doi.org/10.1007/s11605-019-04389-5