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Surgical practice patterns and outcomes in T2 and T3 gallbladder cancer: a population-based study
Senthuran Tharmalingam1, Jennifer Flemming2, Harriet Richardson2
1From the Department of Surgery, Queen's University, Kingston, Ont. (Tharmalingam, Nanji); the Department of Medicine, Queen's University, Kingston, Ont. (Flemming); the Department of Public Health Sciences, Queen's University, Kingston, Ont. (Flemming, Richardson); the Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont. (Hurlbut); and the Department of Surgery, Mayo Clinic, Rochester, Minn. (Cleary). 11st21@queensu.ca.
Background:
The extent of resection required in advanced gallbladder cancer is controversial. We aimed to describe the management and outcomes in patients with resected stage T2 and T3 gallbladder cancer.
Methods:
In this population-based study, all T2 and T3 gallbladder cancer cases from Jan. 1, 2002, to Mar. 31, 2012, were identified from the Ontario Cancer Registry; pathology reports were linked and abstracted. The type of resection was classified as extended (cholecystectomy + liver resection, with or without bile duct resection) or simple (cholecystectomy only). We used Kaplan-Meier survival analysis to model time to death and evaluated factors associated with overall survival using the Cox proportional hazards regression model.
Results:
A total of 370 patients were included, 232 with T2 disease and 138 with T3 disease. The proportions who underwent extended resection were 24.1% (56/232) and 37.0% (51/138), respectively. The unadjusted 5-year overall survival rates for simple and extended resection were 39.7% and 49.5%, respectively, for T2 disease (p = 0.03), and 13.5% and 22.8%, respectively, for T3 disease (p = 0.05). In adjusted analysis, extended resection significantly improved overall survival among patients with T2 disease (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.30-0.97), whereas higher grade of differentiation, presence of lymphovascular invasion and positive lymph nodes led to worse survival. Extended resection was not associated with improved survival in the T3 group; however, in subgroup analysis stratified by lymph node status, a trend toward improved overall survival with extended resection was seen in node-negative patients (HR 0.20, 95% CI 0.03-1.06).
Conclusion:
Extended resection improved overall survival in T2 disease regardless of nodal status but appeared most beneficial in node-negative T3 disease. The finding that extended resection was offered only to a small proportion of eligible patients highlights the need for improved knowledge translation at national surgical meetings.
