Revision of nationwide practice patterns in the management of T2 gallbladder carcinoma

Abstract

Background: National guidelines recommend en-bloc hepatectomy and lymphadenectomy for stage IB and higher gallbladder cancer (GBC). Compliance with these guidelines has been poor. We sought to assess potential changes in the practice patterns in the surgical management of T2 GBC over the last 3 decades. Methods: A contemporary series from National Cancer Database (NCDB) was queried for patients with T2 disease who underwent resection for GBC from 2004 to 2014 (Period 2). This data was compared with an older large series from SEER (Surveillance Epidemiology End-results) database including T2 GBC patients between 1991 and 2005 (Period 1). Kaplan–Meier log-rank analyses assessed the impact of the definitive surgical approach on survival rates. Results: NCDB and SEER databases identified 11,532 and 2,955 patients, respectively. Among them, 618 (5.3%) and 781 (26.4%) T2 GBC were included in this analysis, respectively. Patients undergoing hepatectomy had improved survival in both periods compared to those who did not undergo hepatectomy (51.7 vs. 25.3 months, p < 0.001 and 53.0 vs. 16.0 months, p < 0.001, respectively). Hepatectomy rates increased by 36% from period 1 to period 2 (13.4% vs. 37.2%, p < 0.001). Portal lymphadenectomy increased by 66.4% between period 1 and period 2 (33.3% vs. 50.1%, p < 0.001). Conclusion: Although there was a significant improvement in the compliance with national guidelines over last 3 decades, major disparities yet exist in the current surgical management of GBC. Only one third of patients with T2 GBC currently undergo appropriate hepatectomy and half of them undergo portal lymphadenectomy. Further studies assessing the impact of noncompliance on outcomes of patients with GBC are warranted. Efforts should be directed towards standardization of nationwide practice patterns in GBC.