Clinical Topics

Surgical Staging Often Inadequate for Gallbladder Cancer

by U.S. Medicine

February 24, 2019

HOUSTON–Guidelines frequently aren’t followed when it comes to radical cholecystectomy with regional lymphadenectomy for patients with T1b gallbladder cancer.

Current clinical practice guidelines recommend radical cholecystectomy with RC-RL for T1 GBC patients. A study in Annals of Surgical Oncology said it remains unclear the extent to which these guidelines are followed, however.1

Researchers from the Michael E. DeBakey VAMC and the Baylor College of Medicine, both in Houston, sought to evaluate current surgical practices for T1b GBC and those affecting overall management strategies and associated outcomes.

Their retrospective cohort study investigated patients identified from the National Cancer Data Base from 2004-2012 with nonmetastatic T1b GBC. Patients were categorized based on type of surgical treatment received: simple cholecystectomy or RC-RL. In addition, among patients who had lymph nodes pathologically examined, nodal status was classified as pN- or pN+.

The study team also determined use of any adjuvant therapy and compared overall survival based on type of surgical treatment and nodal status. Participants were 464 patients–247 SC and 217 RC-RL cases.

Results indicated that positive margin status did not differ between the two groups–6.1% for SC vs. 2.3% for RC-RL; p = 0.128. For RC-RL, the pN+ rate was 15%.

The study determined that adjuvant therapies were used more frequently in pN+ cases–53.1% vs. 9.4% for pN-, and that, by comparison, 10.9% of the SC patients received adjuvant therapy.

Overall survival for RC-RL-pN-, calculated as 64.4% reaching five years, was significantly better than for RC-RL-pN+, where only 15.7% reached five years or SC, were 48.3% achieved five years.

“Less than 50% of the patients with a T1b GBC primary tumor undergo the recommended surgical treatment,” study authors wrote. “Given that 15% of these patients have nodal metastasis and in light of the previously described benefits of adjuvant therapy for node positive GBC, failure to perform RC-RL risks incomplete staging and thus undertreatment for patients with T1b GBC.”

1. Vo E, Curley SA, Chai CY, Massarweh NN, Tran Cao HS. National Failure of Surgical Staging for T1b Gallbladder Cancer. Ann Surg Oncol. 2018 Nov 29. doi: 10.1245/s10434-018-7064-7. [Epub ahead of print] PubMed PMID: 30499077.

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