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Comparative Study
. 2013 Jan;15(1):40-8.
doi: 10.1111/j.1477-2574.2012.00559.x. Epub 2012 Sep 26.

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

Danielle M Hari  1 , J Harrison Howard, Anna M Leung, Connie G Chui, Myung-Shin Sim, Anton J Bilchik
Affiliations
Comparative Study

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

Danielle M Hari et al. HPB (Oxford). 2013 Jan.

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.

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Figures

Figure 1
Figure 1
Types of surgery performed in tumour stage I (T1) gallbladder carcinoma. Green bars, radical cholecystectomy; blue bars, cholecystectomy plus lymph node resection; purple bars, cholecystectomy only; T1NOS, T1 not otherwise specified
Figure 2
Figure 2
Kaplan–Meier curves for disease-specific survival in patients with tumour stage I (T1) gallbladder carcinoma by type of surgery (P < 0.0001). C + LN, cholecystectomy plus lymph node resection; RC, radical cholecystectomy
Figure 3
Figure 3
Kaplan–Meier curves for overall survival in patients with tumour stage I (T1) gallbladder carcinoma by type of surgery (P < 0.0001). C + LN, cholecystectomy plus lymph node resection; RC, radical cholecystectomy
Figure 4
Figure 4
Kaplan–Meier curves for disease-specific survival in patients with (a) tumour stage Ia (T1a) (P = 0.614) and (b) tumour stage Ib (T1b) (P = 0.0002) gallbladder carcinoma, by type of surgery. C + LN, cholecystectomy plus lymph node resection; RC, radical cholecystectomy
Figure 5
Figure 5
Kaplan–Meier curves for overall survival in patients with (a) tumour stage Ia (T1a) (P = 0.9314) and (b) tumour stage Ib (T1b) (P = 0.0172) gallbladder carcinoma. C + LN, cholecystectomy plus lymph node resection; RC, radical cholecystectomy
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References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29. - PubMed
    1. Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior non-curative intervention. Ann Surg. 2000;232:557–569. - PMC - PubMed
    1. Shimada H, Endo I, Togo S, Nakano A, Izumi T, Nakagawara G. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer. 1997;79:892–899. - PubMed
    1. Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA. Carcinoma of the gallbladder. Does radical resection improve outcome? Arch Surg. 1990;125:237–241. - PubMed
    1. Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M. Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg. 1991;15:337–343. - PubMed

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