Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection.

Hypothesis Extended surgical resection (ESR) may improve survival in patients with early-stage primary gallbladder cancer. Design Retrospective analysis of findings in the Surveillance, Epidemiology, and End Results (SEER) database. Setting Academic research. Patients Individuals with potentially surgically curable gallbladder cancer (Tis, T1, or T2) who underwent a surgical procedure. Main Outcome Measures Overall survival, number of lymph nodes (LNs) excised, and results of simple cholecystectomy vs ESR. Results We identified 3209 patients with early-stage gallbladder cancer (11.7% Tis, 30.1% T1, and 58.2% T2). On multivariate analysis, decreased survival was noted among patients older than 60 years (hazard ratio, 1.57; 95% confidence interval, 1.30-1.90), among patients with more advanced cancer (1.99; 1.46-2.70 for T1; 3.29; 2.45-4.43 for T2), and among patients with disease-positive LNs (1.65; 1.39-1.95 for regional; 2.58; 1.54-4.34 for distant) ( P P  = .02) and among patients undergoing ESR (0.59; 0.45-0.78; P P P P  = .03). Lymph node excision improved survival in patients with T2 lesions (0.42; 0.33-0.53; P Conclusion Extended surgical resection, LN excision, or both may improve survival in certain patients with incidentally discovered gallbladder cancer.