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01-10-2010 | 2010 SSAT Plenary Presentation

National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years: A Population-Based Analysis

Authors: Skye C. Mayo, Andrew D. Shore, Hari Nathan, Barish Edil, Christopher L. Wolfgang, Kenzo Hirose, Joseph Herman, Richard D. Schulick, Michael A. Choti, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 10/2010

Abstract

Introduction

National Comprehensive Cancer Network (NCCN) guidelines recommend hepatic resection and lymphadenectomy (LND) for gallbladder adenocarcinoma (GBA). We sought to evaluate compliance with these recommendations and to assess trends in the management and survival of patients with GBA.

Methods

Using Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data, we identified 2,955 patients with GBA who underwent cancer-directed surgery from 1991 to 2005. We assessed clinicopathologic data, trends in surgical management, and survival.

Results

From 1991 to 2005, preoperative evaluation included CT (62%), MRI (6%), and PET (2%). Only 383 (13%) patients underwent radical resection/hepatectomy with a temporal increase over the study period (1991–1995, 12%; 1996–1999, 10%; 2000–2002, 12.0%; 2003–2005, 16%; P < 0.001). For patients undergoing radical resection/hepatectomy, LND ≥ 3 nodes was performed in 96 (3%) patients. Among patients who had LND, 47% had nodal metastasis. The overall 1-, 3-, and 5-year survival was 56%, 30%, and 21%. On multivariate analysis, radical resection/hepatectomy (hazard ratio (HR) = 0.71) and LND ≥ 3 nodes (HR = 0.56) were independently associated with increased survival. There was no significant improvement in survival over time (P = 0.60).

Conclusions

Compliance with NCCN guidelines for GBA remains poor. Survival of patients with surgically managed GBA has not improved over time.

Horner MJ RL, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2006, National Cancer Institute. Bethesda, MD. Available at: http://seer.cancer.gov/csr/1975_2006/. Based on November 2008 SEER data submission, posted to the SEER web site, 2009.

Shih SP, Schulick RD, Cameron JL, et al. Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 2007; 245(6):893–901.CrossRefPubMed

Fong Y, Malhotra S. Gallbladder cancer: recent advances and current guidelines for surgical therapy. Adv Surg 2001; 35:1–20.PubMed

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.CrossRefPubMed

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.CrossRefPubMed

Balachandran P, Agarwal S, Krishnani N, et al. Predictors of long-term survival in patients with gallbladder cancer. J Gastrointest Surg 2006; 10(6):848–854.CrossRefPubMed

Dixon E, Vollmer CM, Jr., Sahajpal A, et al. An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center. Ann Surg 2005; 241(3):385–394.CrossRefPubMed

Pawlik TM, Gleisner AL, Vigano L, et al. Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg 2007; 11(11):1478–86; discussion 1486–7.CrossRefPubMed

10.

American Joint Commission on Cancer (2010) American Cancer Society, 7th ed. New York, NY: Springer

11.

Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 1994; 219(3):275–280.CrossRefPubMed

12.

Kokudo N, Makuuchi M, Natori T, et al. Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 2003; 138(7):741–750; discussion 750.CrossRefPubMed

13.

D’Angelica M, Brennan MF, Fortner JG, et al. Ninety-six five-year survivors after liver resection for metastatic colorectal cancer. J Am Coll Surg 1997; 185(6):554–559.CrossRefPubMed

14.

Konstantinidis IT, Deshpande V, Genevay M, et al. Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience. Arch Surg 2009; 144(5):441–447; discussion 447.CrossRefPubMed

15.

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.PubMed

16.

Jensen EH, Abraham A, Habermann EB, et al. A critical analysis of the surgical management of early-stage gallbladder cancer in the United States. J Gastrointest Surg 2009; 13(4):722–727.CrossRefPubMed

17.

Jensen EH, Abraham A, Jarosek S, et al. Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer. Surgery 2009; 146(4):706–711; discussion 711–3.CrossRefPubMed

18.

Coburn NG, Cleary SP, Tan JC, et al. Surgery for gallbladder cancer: a population-based analysis. J Am Coll Surg 2008; 207(3):371–382.CrossRefPubMed

19.

Cooper GS, Virnig B, Klabunde CN, et al. Use of SEER-Medicare data for measuring cancer surgery. Med Care 2002; 40(8 Suppl):IV-43-8.

20.

National Cancer Institute D, Surveillance Research Program, Cancer Statistics Branch. Surveillance, epidemiology, and end results (SEER) program. Available at: (http://www.seer.cancer.gov). SEER* Stat database: Incidence, SEER 17 regs public-use, Nov 2005 sub (1973–2003 varying), linked to county attributes, total US, 1969–2003 counties. Released April 2006, based on the November 2005 submission.

21.

Warren JL, Klabunde CN, Schrag D, et al. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 2002; 40(8 Suppl):IV-3-18.

22.

Fritz AG. International Classification of Diseases for Oncology: ICD-O, 3rd ed. Geneva: World Health Organization 2000.

23.

American Joint Commission on Cancer, American Cancer Society. 6th ed. New York: Springer, 2002

24.

SEER program coding and staging manual. Bethesda, MD: National Cancer Institute, 2007.

25.

Morris AM, Baldwin LM, Matthews B, et al. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 2007; 245(1):73–79.CrossRefPubMed

26.

Potosky AL, Warren JL, Riedel ER, et al. Measuring complications of cancer treatment using the SEER-Medicare data. Med Care 2002; 40(8 Suppl):IV-62-8.

27.

Kaplan EL MP. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53:457–481.CrossRef

28.

Cox D. Regression models and life tables. J R Stat Soc B 1972; 34:187–220.

29.

Hosmer DW, Lemeshow S. Applied Survival Analysis: Regression modeling of time to event data. 2nd ed. New York: John Wiley and Sons, Inc., 1999.

30.

May S, Hosmer DW. A simplified method of calculating an overall goodness-of-fit test for the Cox proportional hazards model. Lifetime Data Anal 1998; 4(2):109–120.CrossRefPubMed

31.

Agresti A. Introduction to categorical data analysis. New York: Wiley, 1996. pp. 231–236.

32.

Nathan H, Pawlik TM. Limitations of claims and registry data in surgical oncology research. Ann Surg Oncol 2008; 15(2):415–423.CrossRefPubMed

33.

Kim SJ, Lee JM, Lee JY, et al. Accuracy of preoperative T-staging of gallbladder carcinoma using MDCT. AJR Am J Roentgenol 2008; 190(1):74–80.CrossRefPubMed

34.

Rao ND, Gulati MS, Paul SB, et al. Three-dimensional helical computed tomography cholangiography with minimum intensity projection in gallbladder carcinoma patients with obstructive jaundice: comparison with magnetic resonance cholangiography and percutaneous transhepatic cholangiography. J Gastroenterol Hepatol 2005; 20(2):304–308.CrossRefPubMed

35.

Park HS, Lee JM, Choi HK, et al. Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J Magn Reson Imaging 2009; 30(3):586–595.CrossRefPubMed

36.

Manfredi R, Mehrabi S, Motton M, et al. MR imaging and MR cholangiopancreatography of multifocal intraductal papillary mucinous neoplasms of the side branches: MR pattern and its evolution. Radiol Med 2008; 113(3):414–428.CrossRefPubMed

37.

Guiu B, Loffroy R, Ben Salem D, et al. Combined SPIO-gadolinium magnetic resonance imaging in cirrhotic patients: negative predictive value and role in screening for hepatocellular carcinoma. Abdom Imaging 2008; 33(5):520–528.CrossRefPubMed

38.

Hueman MT, Vollmer CM, Jr., Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol 2009; 16(8):2101–2115.CrossRefPubMed

39.

Corvera CU, Blumgart LH, Akhurst T, et al. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg 2008; 206(1):57–65.CrossRefPubMed

40.

Pawlik TM, Choti MA. Biology dictates prognosis following resection of gallbladder carcinoma: sometimes less is more. Ann Surg Oncol. 2009; 16(4):787–788.CrossRefPubMed

41.

D’Angelica M, Dalal KM, DeMatteo RP, et al. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol 2009; 16(4):806–816.CrossRefPubMed

42.

Tsao JI, Loftus JP, Nagorney DM, et al. Trends in morbidity and mortality of hepatic resection for malignancy. A matched comparative analysis. Ann Surg 1994; 220(2):199–205.CrossRefPubMed

43.

Thompson HH, Tompkins RK, Longmire WP, Jr. Major hepatic resection. A 25-year experience. Ann Surg 1983; 197(4):375–388.CrossRefPubMed

44.

Bentrem DJ, Dematteo RP, Blumgart LH. Surgical therapy for metastatic disease to the liver. Annu Rev Med 2005; 56:139–156.CrossRefPubMed

45.

Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230(3):309–318; discussion 318–21.CrossRefPubMed

46.

Bozzetti F, Gennari L, Regalia E, et al. Morbidity and mortality after surgical resection of liver tumors. Analysis of 229 cases. Hepatogastroenterology 1992; 39(3):237–241.PubMed

47.

Taylor M, Forster J, Langer B, et al. A study of prognostic factors for hepatic resection for colorectal metastases. Am J Surg 1997; 173(6):467–471.CrossRefPubMed

48.

Capussotti L, Polastri R. Operative risks of major hepatic resections. Hepatogastroenterology 1998; 45(19):184–190.PubMed

49.

Asiyanbola B, Chang D, Gleisner AL, et al. Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg 2008; 12(5):842–851.CrossRefPubMed

50.

Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 2000; 232(4):557–569.CrossRefPubMed

51.

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.CrossRefPubMed

Title: National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years: A Population-Based Analysis
Authors: Skye C. Mayo
Andrew D. Shore
Hari Nathan
Barish Edil
Christopher L. Wolfgang
Kenzo Hirose
Joseph Herman
Richard D. Schulick
Michael A. Choti
Timothy M. Pawlik
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-010-1335-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years: A Population-Based Analysis

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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