DISPARITIES IN TREATMENT FOR GALL BLADDER CARCINOMA: DOES TREATMENT SITE MATTER?
Atlee M. Melillo*, Kimberly M. Linden, Gaughan John, Umur Atabek, Francis Spitz, Young Hong
General Surgery, Cooper University Hospital, Camden, NJ
Introduction:
Gallbladder carcinoma is a rare malignancy in the United States that often has a poor prognosis. Given the rarity of the disease, the surgical and medical treatment patterns across various treatment centers are often undefined. Thus, we aim to determine the treatment and outcome disparity across different treatment centers.
Methods:
The National Cancer Database was queried for gallbladder carcinoma between 2004 and 2014. The cases were stratified by treatment site into either "Academic Research Center"? (ARC) or "Community Cancer Program"? (CCP) and treatment type as "Radical"? or "Simple"? cholecystectomy. A propensity score matched analysis was performed for patient age, sex, race, education, income, insurance, Charlson/Deyo Score and tumor size. The primary outcome variables were 30-day and 90-day mortality as well as overall survival between ARC and CCP.
Results:
A total of 3038 cases were identified for propensity score analysis with 1473 (48.48%) from ARC and 1565 (51.51%) from CCP. Radical cholecystectomy was performed in 838 (56.89%) at ARC vs. 681 (43.5%) at CCP (p < 0.01) while simple cholecystectomy was performed in 635 (43.11%) at ARC vs. 884 (56.48%) at CCP (p<0.0001). There was lower 30-day and 90-day mortality at ARCs 33 (4.48%) vs. 50 (8.33%) (p < 0.01) and 71(9.7%) vs. 120 (20.2%) (p<0.01) for radical cholecystectomy and 14 (2.54%) at ARC vs. 53 (6.8%) at CCP (p < 0.01) and 52 (9.57%) vs. 142 (18.5%) for simple cholecystectomy, respectively. Adjuvant therapy was administered in 44.5% of cases at ARC vs. 39.9% at CCP (p= 0.02). Assessing propensity matched overall survival, there was a significant increase in overall survival for both radical and simple cholecystectomy at ARCs compared to CCPs at 1 year (66.6% vs 55.1%), 3-year (39.1%vs 31.2%), 5-year (30.3% vs 24.2%) and 10-year (23.1% vs 16.9%) (p<0.01).
Conclusions:
There were lower 30-day and 90-day mortality associated with both simple and radical cholecystectomy at tertiary academic centers with higher 1-, 3-, 5-, and 10-year overall survival. There was a higher percentage of adjuvant therapy administered at these academic centers. Referral of gallbladder carcinoma care to a tertiary academic center should be considered.
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