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

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

Research output: Contribution to journalArticle

69 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1578-1591
Number of pages14
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number10
DOIs
StatePublished - 2010

Fingerprint

Gallbladder
Adenocarcinoma
Survival
Hepatectomy
Population
Guidelines
Neoplasms
Medicare
Lymph Node Excision
Epidemiology
Multivariate Analysis
Neoplasm Metastasis
Liver

Keywords

  • Gallbladder cancer
  • Medicare
  • SEER
  • Surgery
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years : A Population-Based Analysis. / Mayo, Skye C.; Shore, Andrew D.; Nathan, Hari; Edil, Barish; Wolfgang, Christopher L.; Hirose, Kenzo; Herman, Joseph; Schulick, Richard D.; Choti, Michael A.; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 10, 2010, p. 1578-1591.

Research output: Contribution to journalArticle

Mayo, SC, Shore, AD, Nathan, H, Edil, B, Wolfgang, CL, Hirose, K, Herman, J, Schulick, RD, Choti, MA & Pawlik, TM 2010, 'National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years: A Population-Based Analysis', Journal of Gastrointestinal Surgery, vol. 14, no. 10, pp. 1578-1591. https://doi.org/10.1007/s11605-010-1335-3
Mayo, Skye C. ; Shore, Andrew D. ; Nathan, Hari ; Edil, Barish ; Wolfgang, Christopher L. ; Hirose, Kenzo ; Herman, Joseph ; Schulick, Richard D. ; Choti, Michael A. ; Pawlik, Timothy M. / National Trends in the Management and Survival of Surgically Managed Gallbladder Adenocarcinoma Over 15 years : A Population-Based Analysis. In: Journal of Gastrointestinal Surgery. 2010 ; Vol. 14, No. 10. pp. 1578-1591.
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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.",
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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

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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.

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KW - SEER

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KW - Survival

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