Management of T2 gallbladder cancer: are practice patterns consistent with national recommendations?
| Autor: | D. Iddings, Maihgan A. Kavanagh, Chris C. Lee, Anton J. Bilchik, Byron E. Wright |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Population Comorbidity Bile duct cancer Epidemiology medicine Humans Cholecystectomy Practice Patterns Physicians' Gallbladder cancer education Survival analysis Aged Neoplasm Staging Aged 80 and over education.field_of_study Chi-Square Distribution business.industry Gallbladder General Medicine Middle Aged medicine.disease Survival Analysis Surgery medicine.anatomical_structure Lymph Node Excision Female Gallbladder Neoplasms business Chi-squared distribution SEER Program |
| Zdroj: | The American Journal of Surgery. 194:820-826 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2007.08.032 |
| Popis: | Background The national recommendation for the management of localized T2 gallbladder cancer (GBCA) is radical cholecystectomy. Although reported survival for localized T2 disease has been poor, groups have documented improvement with radical resection. We hypothesized that a discrepancy exists between national recommendations and current practice patterns. Methods Patients diagnosed with localized T2 GBCA between 1988 and 2002 were identified from the Surveillance, Epidemiology, and End Results registry. Age, sex, race, ethnicity, extent of surgery, and overall survival were assessed. Surgical procedure was categorized as cholecystectomy alone (CS), cholecystectomy plus lymph node dissection (CS+LN), radical cholecystectomy (RCS), or other. Survival calculations were made using the Kaplan-Meier method and compared with the log-rank test. Results Of 382 patients with pathologically confirmed T2 GBCA, 280 were women. The median patient age was 75 years. A total of 238 patients underwent CS, 76 underwent CS+LN, and 14 underwent RCS. The remaining 54 patients underwent a lesser or no procedure and were excluded from comparative analysis. The median survival was 14 months for all patients and 14, 14, and 8 months for subgroups treated with CS, CS+LN, and RCS, respectively. Rates of 5-year survival were 23%, 24%, and 36% for CS, CS+LN, and RCS subgroups, respectively. There was no significant difference in survival rates between RCS and CS+LN, or between RCS and CS. Conclusions The majority of patients with T2 GBCA in the United States are not managed according to current national recommendations. |
| Databáze: | OpenAIRE |
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