Surgical practice patterns and outcomes in T2 and T3 gallbladder cancer: insights from a population based study

dc.contributor.authorTharmalingam, Senthuranen
dc.contributor.departmentPublic Health Sciencesen
dc.contributor.supervisorRichardson, Harrieten
dc.date.accessioned2017-04-28T15:28:17Z
dc.date.available2017-04-28T15:28:17Z
dc.degree.grantorQueen's University at Kingstonen
dc.description.abstractBackground: Gallbladder cancer (GBC) is a lethal malignancy. Surgery remains the only option for cure. Our study aimed to evaluate practice patterns in patients with stage T2 and T3 GBC and describe the association between the extent of surgical resection and overall survival. Methods: This was a population-based cohort study from 2002-2012 including all cases of GBC in Ontario identified using the Ontario Cancer Registry (OCR). Those who underwent surgical resection were identified using linked administrative datasets and their pathology reports were abstracted to identify T2 and T3 GBCs. Type of surgical resection was classified as ‘extended’ (cholecystectomy + liver resection and/or bile duct resection) or ‘simple’ (cholecystectomy only). The association between type of surgical resection and OS was explored using Cox proportional hazards regression models. Results: 232 cases of T2 and 138 cases of T3 GBC were identified with 24% (56/232) of T2 cases and 37% (51/138) of T3 cases receiving extended resection. Unadjusted overall 5-year survival for simple vs extended resection was 39.7% vs 49.5% for T2 GBC (p =0.03) and 13.5% vs 22.8% for T3 GBC respectively (p=0.05). In T2 adjusted analysis, extended resection was associated with improved overall survival (OS) (HR = 0.51; 95% CI 0.30 -0.97, P = 0.01), while poor differentiation (HR = 3.42; 95% CI 1.92 -6.08, P = 0.0001), presence of lymphovascular invasion (HR = 1.75; 95% CI 1.16 -2.64, P = 0.03), and positive lymph nodes (HR = 1.78; 95% CI 1.03 -3.08, P = 0.03) was associated with worse OS. In T3 adjusted analysisc, only female sex (HR = 0.66; 95% CI 0.43-1.00, P = 0.05) was a predictor of improved OS, while older age (HR = 1.04; 95% CI 1.02-1.04, P = 0.0005) was associated with worse OS. On stratified analysis, extended resection demonstrated a trend towards improved survival in node negative cases only (HR=0.20; CI 0.03-1.06, P=0.07). Conclusions: The use of extended resection for T2 and T3 GBC in Ontario is modest. Extended resection is associated with improved OS in all T2 disease and node negative T3 disease.en
dc.description.degreePhDen
dc.embargo.liftdate2022-04-28T12:27:06Z
dc.embargo.termsI wish to submit the results to a scholarly journal for publication.en
dc.identifier.urihttp://hdl.handle.net/1974/15745
dc.language.isoengen
dc.relation.ispartofseriesCanadian thesesen
dc.rightsCC0 1.0 Universalen
dc.rightsQueen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canadaen
dc.rightsProQuest PhD and Master's Theses International Dissemination Agreementen
dc.rightsIntellectual Property Guidelines at Queen's Universityen
dc.rightsCopying and Preserving Your Thesisen
dc.rightsThis publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.en
dc.rights.urihttp://creativecommons.org/publicdomain/zero/1.0/
dc.subjectGallbladder Canceren
dc.subjectExtended Resectionen
dc.subjectPopulation-Based Studyen
dc.subjectOverall Survivalen
dc.titleSurgical practice patterns and outcomes in T2 and T3 gallbladder cancer: insights from a population based studyen
dc.typethesisen
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