title: National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Harvey 611, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Skye C
authors.initials: SC
authors.lastname: Mayo
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shore
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: Barish
authors.initials: B
authors.lastname: Edil
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Joseph
authors.initials: J
authors.lastname: Herman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000639:trends; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000601:surgery*; D019983:Guideline Adherence; D006498:Hepatectomy / Q000639:trends; D006801:Humans; D008197:Lymph Node Excision / Q000639:trends; D008297:Male; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D014481:United States
references.citation: Arch Surg. 2003 Jul;138(7):741-50; discussion 750
references.pmid: 12860755
references.citation: Ann Surg. 2000 Oct;232(4):557-69
references.pmid: 10998654
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references.pmid: 12187163
references.citation: Ann Surg Oncol. 2009 Aug;16(8):2101-15
references.pmid: 19495882
references.citation: Ann Surg Oncol. 2009 Apr;16(4):787-8
references.pmid: 19165545
references.citation: Hepatogastroenterology. 1992 Jun;39(3):237-41
references.pmid: 1505895
references.citation: J Gastrointest Surg. 2008 May;12(5):842-51
references.pmid: 18266046
references.citation: J Gastrointest Surg. 2009 Apr;13(4):722-7
references.pmid: 19083068
references.citation: J Gastroenterol Hepatol. 2005 Feb;20(2):304-8
references.pmid: 15683436
references.citation: Ann Surg. 1994 Aug;220(2):199-205
references.pmid: 8053742
references.citation: J Magn Reson Imaging. 2009 Sep;30(3):586-95
references.pmid: 19711405
references.citation: Am Surg. 2001 Nov;67(11):1041-7
references.pmid: 11730220
references.citation: Lifetime Data Anal. 1998;4(2):109-20
references.pmid: 9658770
references.citation: Ann Surg. 2005 Mar;241(3):385-94
references.pmid: 15729060
references.citation: Arch Surg. 2009 May;144(5):441-7; discussion 447
references.pmid: 19451486
references.citation: Am J Surg. 2007 Dec;194(6):820-5; discussion 825-6
references.pmid: 18005778
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-43-8
references.pmid: 12187167
references.citation: Abdom Imaging. 2008 Sep-Oct;33(5):520-8
references.pmid: 17912584
references.citation: Ann Surg. 1983 Apr;197(4):375-88
references.pmid: 6299217
references.citation: Ann Surg. 1999 Sep;230(3):309-18; discussion 318-21
references.pmid: 10493478
references.citation: AJR Am J Roentgenol. 2008 Jan;190(1):74-80
references.pmid: 18094296
references.citation: Ann Surg Oncol. 2007 Feb;14(2):833-40
references.pmid: 17103074
references.citation: Ann Surg Oncol. 2008 Feb;15(2):415-23
references.pmid: 17987343
references.citation: Radiol Med. 2008 Apr;113(3):414-28
references.pmid: 18493777
references.citation: Adv Surg. 2001;35:1-20
references.pmid: 11579805
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-62-8
references.pmid: 12187170
references.citation: Ann Surg. 2007 Jan;245(1):73-9
references.pmid: 17197968
references.citation: J Gastrointest Surg. 2007 Nov;11(11):1478-86; discussion 1486-7
references.pmid: 17846848
references.citation: Surgery. 2009 Oct;146(4):706-11; discussion 711-3
references.pmid: 19789030
references.citation: Ann Surg Oncol. 2009 Apr;16(4):806-16
references.pmid: 18985272
references.citation: Ann Surg. 1994 Mar;219(3):275-80
references.pmid: 8147608
references.citation: J Am Coll Surg. 1997 Dec;185(6):554-9
references.pmid: 9404879
references.citation: J Am Coll Surg. 2008 Sep;207(3):371-82
references.pmid: 18722943
references.citation: Am J Surg. 1997 Jun;173(6):467-71
references.pmid: 9207156
references.citation: J Surg Oncol. 2008 Feb 1;97(2):156-64
references.pmid: 18050290
references.citation: J Gastrointest Surg. 2006 Jun;10(6):848-54
references.pmid: 16769541
references.citation: Annu Rev Med. 2005;56:139-56
references.pmid: 15660506
references.citation: Hepatogastroenterology. 1998 Jan-Feb;45(19):184-90
references.pmid: 9496510
references.citation: J Am Coll Surg. 2008 Jan;206(1):57-65
references.pmid: 18155569
references.citation: Ann Surg. 2007 Jun;245(6):893-901
references.pmid: 17522515