National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis.
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.
Mayo
Skye C
SC
Department of Surgery, The Johns Hopkins University School of Medicine, Harvey 611, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Shore
Andrew D
AD
Nathan
Hari
H
Edil
Barish
B
Wolfgang
Christopher L
CL
Hirose
Kenzo
K
Herman
Joseph
J
Schulick
Richard D
RD
Choti
Michael A
MA
Pawlik
Timothy M
TM
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
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