TY - JOUR
T1 - Rates, Predictors, and Outcomes of Portal Lymphadenectomy for Resectable Gallbladder Cancer
AU - Kemp Bohan, Phillip M.
AU - O’Shea, Anne E.
AU - Ellis, Oriana V.
AU - Chick, Robert C.
AU - Clem, Alex M.
AU - Kirby, Derek T.
AU - Bader, Julia O.
AU - Newhook, Timothy E.
AU - Clifton, G. Travis
AU - Tzeng, Ching Wei D.
AU - Nelson, Daniel W.
AU - Vreeland, Timothy J.
N1 - Publisher Copyright:
© 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
PY - 2021/6
Y1 - 2021/6
N2 - Introduction: Lymphadenectomy (LND) is recommended following surgical resection of ≥ T1b gallbladder cancer (GBC). However, frequency and stage-specific survival benefits of LND remain unclear. Patients and Methods: The National Cancer Database (NCDB; 2006-15) was queried for resected pathologic stage I–III GBC. LND performance, predictors of receiving LND, and LND association with overall survival (OS) were assessed. Results: Of 2302 total patients, 1343 (58.3%) underwent LND. Patients who underwent LND were younger and more frequently had private health insurance, a negative surgical margin, higher pathologic T stage, and received adjuvant chemotherapy (all p < 0.001). LND rates were highest at academic centers (70.1%) relative to all other facility types (p < 0.001). LND was independently associated with improved OS [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.44–0.61]. LND was associated with improved OS for pT1b, pT2, and pT3 patients (all p < 0.05) on univariate analysis. LND was independently associated with improved OS in pT2 (HR 0.44, CI 0.35–0.56) and pT3 (HR 0.54, CI 0.43–0.69) patients. Conclusions: LND is associated with a 48% reduction in risk of death in patients with resectable non-metastatic GBC, with greatest impact in pT2–3 patients. Patients without LND have similar OS to patients with node-positive disease, highlighting the importance of LND. Underutilization of LND likely results in undertreatment of patients with undiagnosed nodal disease, which may contribute to unfavorable oncologic outcomes.
AB - Introduction: Lymphadenectomy (LND) is recommended following surgical resection of ≥ T1b gallbladder cancer (GBC). However, frequency and stage-specific survival benefits of LND remain unclear. Patients and Methods: The National Cancer Database (NCDB; 2006-15) was queried for resected pathologic stage I–III GBC. LND performance, predictors of receiving LND, and LND association with overall survival (OS) were assessed. Results: Of 2302 total patients, 1343 (58.3%) underwent LND. Patients who underwent LND were younger and more frequently had private health insurance, a negative surgical margin, higher pathologic T stage, and received adjuvant chemotherapy (all p < 0.001). LND rates were highest at academic centers (70.1%) relative to all other facility types (p < 0.001). LND was independently associated with improved OS [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.44–0.61]. LND was associated with improved OS for pT1b, pT2, and pT3 patients (all p < 0.05) on univariate analysis. LND was independently associated with improved OS in pT2 (HR 0.44, CI 0.35–0.56) and pT3 (HR 0.54, CI 0.43–0.69) patients. Conclusions: LND is associated with a 48% reduction in risk of death in patients with resectable non-metastatic GBC, with greatest impact in pT2–3 patients. Patients without LND have similar OS to patients with node-positive disease, highlighting the importance of LND. Underutilization of LND likely results in undertreatment of patients with undiagnosed nodal disease, which may contribute to unfavorable oncologic outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85101008648&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101008648&partnerID=8YFLogxK
U2 - 10.1245/s10434-021-09667-8
DO - 10.1245/s10434-021-09667-8
M3 - Article
C2 - 33566248
AN - SCOPUS:85101008648
SN - 1068-9265
VL - 28
SP - 2960
EP - 2972
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -