Variations in surgical treatment of stage I gallbladder carcinoma impacts survival.

Abstract

495 Background: Variations in surgical care for stage I gallbladder carcinoma (GBC) may be associated with inferior outcomes. The aim of this study was to identify the variations in surgical treatment of GBC. Methods: All patients diagnosed with stage I GBC by AJCC 8 criteria from 2004-2013 were identified in the NCDB. Surgical treatment was categorized as cholecystectomy (C), cholecystectomy with lymph node dissection (C+LND), or radical cholecystectomy (RC). Independent predictors of improved overall survival (OS) and extent of surgery were identified by multinomial regression analyses. Results: Of 1756 patients with stage I GBC, 26% were T1a, 56% T1b, and 18.5% T1NOS. The majority were White non-Hispanic (61.8%) and female (68.5%), with 55.1% > 70 years of age. Two-thirds of T1a tumors were treated with more aggressive surgery (28% C+LND, 4.2% RC), which did not differ by age. However, only 44.4% of patients with T1b tumors had more aggressive surgery, which was significantly less likely in patients > 70 years, even after controlling for other factors (C+LND (OR:0.60; CI:0.44-0.81), RC (OR:0.52; CI:0.29-0.91)). Five-year OS was 54.34% for T1a and 43.05% for T1b (p = 0.02). After controlling for other factors, both C+LND (HR:0.46, CI:0.26-0.81) and RC (HR:0.31, CI:0.16-0.62) significantly improved 5-year OS for T1b tumors, whereas RC also improved 5-year OS for all patients > 70 years old (p = 0.04). Conclusions: A majority of patients with T1b GBC had less than adequate surgery by the current AJCC staging, which significantly decreased survival in all patients. This was especially evident in older patients who were also the least likely to receive more aggressive surgery.