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Surgical Management of Gallbladder Cancer: Simple versus Extended Cholecystectomy and the Role of Adjuvant Therapy
Gyulnara G Kasumova, Omidreza Tabatabaie, Ayotunde B Fadayomi, Sing Chau Ng, Jennifer F Tseng
Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Boston, MA
Objective: While current guidelines recommend extended/radical cholecystectomy for T2/T3 gallbladder cancer, many are discovered incidentally at laparoscopic cholecystectomy and outcomes of re-resection versus adjuvant therapy remain to be investigated.
Methods: National Cancer Database queried for patients with T2/T3 gallbladder adenocarcinoma 2004-2013 who underwent resection with or without adjuvant chemotherapy and/or radiation. Kaplan-Meier method used to compare overall survival.
Results: 7,770 patients identified, of whom 6,941 (89.3%) underwent cholecystectomy and 829 (10.7%) extended/radical resection. Those undergoing radical surgery versus cholecystectomy were more likely to be: younger (≤70; 62.0% vs 42.4%, p<0.0001), privately insured (32.9% vs 24.5%, p<0.0001), treated at academic facility (51.0% vs 26.6%, p<0.0001), and have T3 disease (66.5% vs 41.3%, p<0.0001). Radical surgery was more likely to result in negative resection margins (66.0% vs 58.4%, p<0.0001). 2,740 (35.3%) received adjuvant therapy, more commonly following radical (44.6%) versus simple resection (34.1%, p<0.0001). Median survival was longer for radical versus simple surgery (16.4 vs 13.2 months, log-rank p=0.0031). However, median survival was significantly longer for radical surgery with adjuvant therapy (22.7 months) than cholecystectomy with adjuvant (16.4 months), which was significantly longer than either cholecystectomy (11.5 months) or radical surgery (10.3 months) alone (all log-rank p≤0.0004).
Conclusions: Adjuvant therapy significantly prolongs survival after resection of T2/T3 tumors. Furthermore, cholecystectomy with adjuvant therapy is superior to radical resection alone and may serve as potential alternative to re-resection.
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