TY - JOUR
T1 - National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years
T2 - A Population-Based Analysis
AU - Mayo, Skye C.
AU - Shore, Andrew D.
AU - Nathan, Hari
AU - Edil, Barish
AU - Wolfgang, Christopher L.
AU - Hirose, Kenzo
AU - Herman, Joseph
AU - Schulick, Richard D.
AU - Choti, Michael A.
AU - Pawlik, Timothy M.
PY - 2010
Y1 - 2010
N2 - 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.
AB - 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.
KW - Gallbladder cancer
KW - Medicare
KW - SEER
KW - Surgery
KW - Survival
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U2 - 10.1007/s11605-010-1335-3
DO - 10.1007/s11605-010-1335-3
M3 - Article
C2 - 20824371
AN - SCOPUS:77957019392
SN - 1091-255X
VL - 14
SP - 1578
EP - 1591
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 10
ER -