Abstract
e16224 Background: Cholangiocarcinoma (CCA) is a malignancy of the epithelial cells of the biliary tree. Surgical treatment is the preferred treatment option for all subtypes, but 5-year survival rates remain low. The surgical approaches used in the treatment of CCA include radical hepatic resection, laparoscopic, and robotic surgery. Although CCA can arise from the intrahepatic bile duct or extrahepatic bile duct, there exists a subtype with the gallbladder as the primary site. While there have been studies comparing outcomes among surgical procedures, there has yet to be a study that explores the impact of surgery on CCA of the gallbladder. The National Cancer Database (NCDB) was analyzed to determine the effects of surgical modality on overall survival. Methods: A retrospective cohort analysis utilizing the NCDB included 1,880 patients diagnosed with CCA (ICD-8160-3) affecting the gallbladder (topography code C23.9) between 2010 and 2020. Surgical modalities included robotic-assisted, minimally invasive, open, or no surgery. Approaches were categorized by the definitive treatment and open surgeries included procedures converted to open and unspecified. Facility structures were categorized as academic facilities versus non-academic facilities and facility type influence on surgical treatment was compared using Pearson Chi-squared tests. Surgical treatment and facility type on overall survival was analyzed by the Kaplan-Meier method. Results: The majority of the cases analyzed were White (74.7%), female (62.4%), and had Medicare as the primary payor at diagnosis (54.9%). The mean age at diagnosis was 68.4 years (min = 24, max = 90, std. deviation = 11.9) with an average Charlson-Deyo score of 0.5. Of the 1,880 patients analyzed, only 328 underwent surgery (17.4%). There was a statistically significant increase in the overall survival of those who underwent surgery (mean = 33.4 months) over those who did not (mean = 14.7 months, p < 0.001). Those at academic facilities had better overall survival than those at non-academic facilities (p < 0.001), but facility type was not statistically significant for whether patients received surgery. However, those at an academic facility were more likely to have open versus minimally invasive surgery (70.0%) compared to those at a non-academic facility (50.%, p < 0.002). Conclusions: We identified that patients who underwent surgery had significantly better overall survival than those who did not with an average difference of 18.7 months. While there was no difference in the likelihood of having surgery at academic vs. non-academic facilities, the overall survival for those at academic facilities was greater and we found that these patients were more likely to have open surgery over minimally invasive surgery. Further study is needed to determine what other biomedical or socioeconomic factors may account for the difference in overall survival at academic facilities.