A 21‐year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate?
Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surge...
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| Published in | HPB (Oxford, England) Vol. 15; no. 1; pp. 40 - 48 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.01.2013
Elsevier Limited Blackwell Publishing Ltd |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1365-182X 1477-2574 1477-2574 |
| DOI | 10.1111/j.1477-2574.2012.00559.x |
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| Abstract | Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival.
The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub‐stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log‐rank and Cox's regression analyses.
Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow‐up of 22 months, 288 (25.8%) had died of GBC. Five‐year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease‐specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013).
In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered. |
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| AbstractList | Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. Methods The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub-stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log-rank and Cox's regression analyses. Results Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow-up of 22months, 288 (25.8%) had died of GBC. Five-year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease-specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013). Conclusions In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered. [PUBLICATION ABSTRACT] Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival.OBJECTIVESGallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival.The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub-stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log-rank and Cox's regression analyses.METHODSThe National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub-stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log-rank and Cox's regression analyses.Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow-up of 22 months, 288 (25.8%) had died of GBC. Five-year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease-specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013).RESULTSOf 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow-up of 22 months, 288 (25.8%) had died of GBC. Five-year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease-specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013).In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered.CONCLUSIONSIn the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered. Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub‐stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log‐rank and Cox's regression analyses. Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow‐up of 22 months, 288 (25.8%) had died of GBC. Five‐year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease‐specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013). In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered. Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. Methods The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub‐stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log‐rank and Cox's regression analyses. Results Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow‐up of 22 months, 288 (25.8%) had died of GBC. Five‐year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively (P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease‐specific survival (P < 0.001), whereas radiation therapy portended worse survival (P = 0.013). Conclusions In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered. Abstract Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard treatment for stage I GBC. This study was conducted in a large cohort of patients with stage I GBC to test the hypothesis that the extent of surgery affects survival. Methods The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients in whom microscopically confirmed, localized (stage I) GBC was diagnosed between 1988 and 2008. Surgical treatment was categorized as cholecystectomy alone, cholecystectomy with lymph node dissection (C + LN) or radical cholecystectomy (RC). Age, gender, race, ethnicity, T1 sub‐stage [T1a, T1b, T1NOS (T1 not otherwise specified)], radiation treatment, extent of surgery, cause of death and survival were assessed by log‐rank and Cox's regression analyses. Results Of 2788 patients with localized GBC, 1115 (40.0%) had pathologically confirmed T1a, T1b or T1NOS cancer. At a median follow‐up of 22 months, 288 (25.8%) had died of GBC. Five‐year survival rates associated with cholecystectomy, C + LN and RC were 50%, 70% and 79%, respectively ( P < 0.001). Multivariate analysis showed that surgical treatment and younger age were predictive of improved disease‐specific survival ( P < 0.001), whereas radiation therapy portended worse survival ( P = 0.013). Conclusions In the largest series of patients with stage I GBC to be reported, survival was significantly impacted by the extent of surgery (LN dissection and RC). Cholecystectomy alone is inadequate in stage I GBC and its use as standard treatment should be reconsidered. |
| Author | Howard, J. Harrison Leung, Anna M. Chui, Connie G. Hari, Danielle M. Sim, Myung‐Shin Bilchik, Anton J. |
| Author_xml | – sequence: 1 givenname: Danielle M. surname: Hari fullname: Hari, Danielle M. organization: Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA – sequence: 2 givenname: J. Harrison surname: Howard fullname: Howard, J. Harrison organization: Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA – sequence: 3 givenname: Anna M. surname: Leung fullname: Leung, Anna M. organization: Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA – sequence: 4 givenname: Connie G. surname: Chui fullname: Chui, Connie G. organization: Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA – sequence: 5 givenname: Myung‐Shin surname: Sim fullname: Sim, Myung‐Shin organization: Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA – sequence: 6 givenname: Anton J. surname: Bilchik fullname: Bilchik, Anton J. email: bilchika@jwci.org organization: Gastrointestinal Research Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23216778$$D View this record in MEDLINE/PubMed |
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| Copyright | 2013 International Hepato-Pancreato-Biliary Association International Hepato-Pancreato-Biliary Association 2012 International Hepato‐Pancreato‐Biliary Association 2012 International Hepato-Pancreato-Biliary Association. Copyright © 2013 International Hepato-Pancreato-Biliary Association Copyright © 2013 International Hepato-Pancreato-Biliary Association 2013 |
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| Snippet | Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the standard... Abstract Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is... Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the... Objectives Gallbladder carcinoma (GBC) is a rare disease that is often diagnosed incidentally in its early stages. Simple cholecystectomy is considered the... |
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| SubjectTerms | Age Factors Aged Aged, 80 and over Carcinoma - mortality Carcinoma - secondary Carcinoma - surgery Cholecystectomy - adverse effects Cholecystectomy - mortality Female Gallbladder Neoplasms - mortality Gallbladder Neoplasms - pathology Gallbladder Neoplasms - surgery Gastroenterology and Hepatology Humans Kaplan-Meier Estimate Lymph Node Excision Lymphatic Metastasis Male Medical research Middle Aged Multivariate Analysis Neoplasm Staging Original Proportional Hazards Models Radiotherapy, Adjuvant Risk Factors SEER Program Surgery Time Factors Treatment Outcome United States - epidemiology |
| Title | A 21‐year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate? |
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