Report on demographics of gall bladder cancer in Delaware and retrospective review of treatment strategies for gallbladder cancer in a large community cancer center

Background: GBC is frequently found incidentally on pathologic review of the removed gallbladder. NCCN guidelines have treatment recommendations based on specific stage of gallbladder cancer (GBC). However, there is limited information on the experience of community cancer centers in treating GBC based on these guidelines.

Objective: To utilize the Delaware cancer registry to describe patients with GBC in Delaware, and to conduct a review of the treatment strategies and outcomes of GBC at a large community cancer center.

Methods: A retrospective cohort study of GBC cases in the state of Delaware utilizing the statewide cancer registry to gather useful demographic and treatment information, such as patient age, gender, date of diagnosis, type of surgeries, systemic or radiation therapy, and survival time. Analysis of surgical management of GBC at Delaware's largest community cancer center comparing their management of patients with different AJCC stages of GBC to the NCCN guidelines.

Results: Our analysis revealed that there were 109 patients diagnosed with GBC in Delaware from 1995 to 2012. The male to female ratio was 2.7:1 and average age at time of diagnosis was 68. Most of GBC diagnosed were stage T2. During this time period, there were 23 extended radical cholecystectomies done for stage T2 and above GBC. Most of the ERC surgeries were performed by fellowship trained surgical oncologists. Our results show that there was mortality benefit in all operable stages of GBC, and the average survival time was higher for all T2 and above stages of GBC.

Conclusion: A statewide cancer registry is instrumental in retrospective review of demographics and treatment outcomes for rare and aggressive tumors such as GBC. We demonstrated that a large community cancer center, such as Christiana Care Health System, with on staff surgical oncologists is capable of providing GBC treatment that is according to NCCN guidelines and comparable to major academic centers based on mortality outcomes.