SIMPLE VS. RADICAL CHOLECYSTECTOMY FOR T1B GALLBLADDER ADENOCARCINOMA
Rebecca Platoff*, Gaughan John, Umur Atabek, Francis Spitz, Young Hong
Surgery, Cooper University Hospital, Philadelphia, PA
Introduction
Gallbladder adenocarcinoma is a rare but devastating disease with a poor overall prognosis. T1a disease, cancer confined to the gallbladder mucosa, is generally treated with simple cholecystectomy. Controversy remains over the ideal surgical approach to T1b disease, cancer that extends to the muscular layer. Previous single institutions studies have shown similar rates of overall survival with either simple cholecystectomy or radical resection in T1b gallbladder adenocarcinoma; however, they tend to be limited by small sample size. We aim to explore the outcomes of simple versus radical cholecystectomy for T1b gallbladder adenocarcinoma using a national cancer database.
Methods
Data from the National Cancer Database (NCDB) for patients with stage T1b adenocarcinoma of the gallbladder undergoing surgery between 2004 and 2014 were analyzed. Outcomes were compared using Fisher's exact test, chi-square, and Kaplan-Meier with a log-rank test using SAS v9.4.
Results
From 2004-2014 there were 1266 patients with stage T1b gallbladder adenocarcinoma. Of these, 923 (79.0%) underwent radical or total resection and 246 (21.0%) underwent simple or partial resection. (The remaining 97 were unknown.) Median survival for patients undergoing radical surgery was 45.83 months (39.13, 53.06) compared with 36.96 months (25.89, 51.32) for those undergoing simple resection (p = 0.0268). At 30 days postoperatively, there were 26 deaths in the radical group and 11 deaths in the simple group (p = 0.2107, odds ratio 1.67 [0.8118 – 3.4396]). At 90 days postoperatively, there were 55 deaths in the radical group and 24 deaths in the simple group (p = 0.0298, odds ratio 1.77 [1.0682 – 2.9374]). There were no statistically significant differences between the groups undergoing simple vs. radical surgery in regards to patient age, sex, race, facility, geographical location, or tumor grade.
Conclusions
Radical cholecystectomy appears to demonstrate survival advantage over simple cholecystectomy for stage T1b gallbladder adenocarcinoma, with a median survival of 45.83 months compared with 36.96 (p = 0.0268). However, radical cholecystectomy appears to be associated with an increased risk of death in the short term, with a statistically significantly increased odds ratio of death within 90 days of surgery.
Figure 1. Log rank test, p = 0.0268
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