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HPB (Oxford). 2019 Apr 23. pii: S1365-182X(19)30496-4. doi: 10.1016/j.hpb.2019.03.370. [Epub ahead of print]

Evolution of surgical management of gallbladder carcinoma and impact on outcome: results from two decades at a single-institution.

Author information

1
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
2
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
3
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
4
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: jarnagiw@mskcc.org.

Abstract

BACKGROUND:

The surgical approach to gallbladder cancer (GBCA) has evolved in recent years, but the impact on outcomes is unknown. This study describes differences in presentation, surgery, chemotherapy strategy, and survival for patients with GBCA over two decades at a tertiary referral center.

METHODS:

A single-institution database was queried for patients with GBCA who underwent surgical evaluation and exploration and was studied retrospectively. Univariate logistic regression was used to assess the relationship between time and treatment. Univariate Cox proportional hazard regression assessed the association between year of diagnosis and survival.

RESULTS:

From 1992 to 2015, 675 patients with GBCA were evaluated and 437 underwent exploration. Complete resection rates increased over time (p < 0.001). In those submitted to complete resection (n = 255, 58.4%), more recent years were associated with lower likelihood of bile duct resection and major hepatectomy but greater odds of neoadjuvant and adjuvant chemotherapy (p < 0.05). No significant association was found between year of diagnosis and OS or RFS (p > 0.05) for patients with complete resection.

CONCLUSION:

Over the study period, GBCA treatment evolved to include fewer biliary and major hepatic resections with no apparent adverse impact on outcome. Further prospective trials, specifically limited to GBCA, are needed to determine the impact of adjuvant chemotherapy.

PMID:
31027875
DOI:
10.1016/j.hpb.2019.03.370

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