Cholecystectomy Alone may be an Inadequate Treatment for Gallbladder Carcinoma

Doctors normally suggest cholecystectomy alone  to treat early (T1) gallbladder carcinoma; even Mayo Clinic offers gallbladder removal as the best option for this rare form of cancer. But leading oncologists question whether cholecystectomy alone is enough. Dr. Anton Bilchik joined a team of other researchers at the Gastrointestinal Research Program at John Wayne Cancer Institute to test the hypothesis that the extent of the surgery affects survival rates.

The team queried the National Cancer Institute’s Surveillance, Epidemiology and End Results database to identify 2788 patients with microscopically confirmed Stage 1 gallbladder carcinoma over a 20-year period between 1998 and 2008.  Dr. Bilchik and the other specialists categorized surgical treatments into three groups: cholecystectomy alone, cholecystectomy with the removal of one or more lymph nodes, and radical cholecystectomy that involves removal of the gallbladder, some of the surrounding tissue, and all of the lymph nodes in the area. This research team also assessed other factors, such as age, additional therapies such as radiation treatment, and overall survival rate.

Of the original 2788 patients, pathological testing confirmed that 1115 patients, or about 40 percent, had Stage 1, T1a, T1b or T1NOS cancer. Dr. Bilchik and the other researchers found that survival rates after five years for patients who had cholecystectomy alone was only about 50 percent. Five-year survival rates for those who had cholecystectomy with lymph node dissection were about 60 percent. About 70 percent of patients who had radical cholecystectomy were still alive five years after the procedure.

Dr. Bilchik and the other researchers found that patients who undergo radical cholecystectomy (with lymph node and adjacent liver removal) have better survival rates than do those who have cholecystectomy alone. Early diagnosis and youth improve outcomes, whereas radiation treatments seem to have little benefit.

Mayo Clinic

http://www.mayoclinic.com/health/gallbladder-cancer/DS00425/DSECTION=treatments-and-drugs

https://www.ncbi.nlm.nih.gov/pubmed/23216778