title: Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection.
abstract: OBJECTIVE
  Extended surgical resection (ESR) may improve survival in patients with early-stage primary gallbladder cancer.
  
  
  METHODS
  Retrospective analysis of findings in the Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  METHODS
  Academic research.
  
  
  METHODS
  Individuals with potentially surgically curable gallbladder cancer (Tis, T1, or T2) who underwent a surgical procedure.
  
  
  METHODS
  Overall survival, number of lymph nodes (LNs) excised, and results of simple cholecystectomy vs ESR.
  
  
  RESULTS
  We identified 3209 patients with early-stage gallbladder cancer (11.7% Tis, 30.1% T1, and 58.2% T2). On multivariate analysis, decreased survival was noted among patients older than 60 years (hazard ratio, 1.57; 95% confidence interval, 1.30-1.90), among patients with more advanced cancer (1.99; 1.46-2.70 for T1; 3.29; 2.45-4.43 for T2), and among patients with disease-positive LNs (1.65; 1.39-1.95 for regional; 2.58; 1.54-4.34 for distant) (P < .001 for all), while increased survival was observed among female patients (0.82; 0.70-0.96; P = .02) and among patients undergoing ESR (0.59; 0.45-0.78; P < .001). The survival advantage of ESR was seen only in patients with T2 lesions (0.49; 0.35-0.68; P < .001). Lymph node excision data were available for a subset of 2507 patients, of whom 68.2% had no LN excised, 28.2% had 1 to 4 LNs excised, and 3.6% had 5 or more LNs excised. On multivariate analysis, patients with 1 to 4 LNs excised had a survival benefit over those with no LN excised (HR, 0.55; 95% CI, 0.46-0.66; P < .001), and patients with 5 or more LNs excised had a survival benefit over patients with 1 to 4 LNs removed (0.63; 0.40-0.96; P = .03). Lymph node excision improved survival in patients with T2 lesions (0.42; 0.33-0.53; P < .001 for patients with 1-4 LNs excised).
  
  
  CONCLUSIONS
  Extended surgical resection, LN excision, or both may improve survival in certain patients with incidentally discovered gallbladder cancer.
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Downing
authors.forename: Kerry-Ann
authors.initials: KA
authors.lastname: Cadogan
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: Suryanarayana M
authors.initials: SM
authors.lastname: Siram
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.forename: LaSalle D
authors.initials: LD
authors.lastname: Leffall
authors.forename: Wayne A I
authors.initials: WA
authors.lastname: Frederick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018426:SEER Program; D015996:Survival Rate