Extent of lymph node dissection in patients with gallbladder cancer.
Published: 11th July 2018
Authors: Y. Kishi, S. Nara, M. Esaki, N. Hiraoka, K. Shimada
Definitions of regional lymph nodes for gallbladder cancer differ according to staging system. Hence, the appropriate extent of lymph node dissection has not yet been standardized.
Pathological stages and disease‐specific survival (DSS) of patients who had undergone surgical resection of gallbladder cancer between 1990 and 2016 were reviewed. Patients with nodal metastases limited to the hepatoduodenal ligament or common hepatic artery, extending to the posterosuperior pancreatic head lymph nodes (PSPLNs), or in nodes along the coeliac axis or superior mesenteric vessels were grouped as having Na, Nb and Nc disease respectively. Metastases beyond these regions were defined as distant metastases (M1). Absence of distant metastasis was expressed as M0.
A total of 259 patients were evaluated. There were 74, 31 and nine patients respectively in the Na, Nb and Nc groups. Twenty‐five, nine and four patients in the respective groups had M1 disease (P = 0·682). The 5‐year DSS rate was comparable between patients with Na M0 and those with Nb M0 disease (36 versus 34 per cent respectively; P = 0·950), whereas the rate in patients with Nc M0 status (0 per cent) was worse than that of patients with Nb M0 (P = 0·017) and comparable to that of patients with M1 disease (14 per cent; P = 0·590). Among 22 patients with Nb M0 disease, the 5‐year DSS rate did not differ between those who had undergone pancreatoduodenectomy and those who had had dissection of PSPLNs without pancreatoduodenectomy (50 versus 30 per cent respectively; P = 0·499).
PSPLNs and nodes along the hepatoduodenal ligament and hepatic artery should be considered regional nodes for gallbladder cancer, and should be resected.Full text
You may also be interested in
Authors: M. Del Chiaro, K. Søreide
Multicentre study of the prognostic impact of preoperative bodyweight on long‐term prognosis of hepatocellular carcinoma.
Authors: J. J. Yu, F. Shen, T. H. Chen, L. Liang, J. Han, H. Xing et al.
Notes: BMI matters
Authors: G. Marchegiani, S. Andrianello, G. Morbin, E. Secchettin, M. D'Onofrio, R. De Robertis et al.
Notes: Duct dilatation no risk alone
Pancreas‐sparing, ampulla‐preserving duodenectomy for major duodenal (D1–D2) perforations. BJS 2018; 105: 1487-1492.
Authors: S. Di Saverio, E. Segalini, A. Birindelli, S. Todero, M. Podda, A. Rizzuto et al.
Notes: Useful option
Profile of exhaled‐breath volatile organic compounds to diagnose pancreatic cancer. BJS 2018; 105: 1493-1500.
Authors: S. R. Markar, B. Brodie, S.‐T. Chin, A. Romano, D. Spalding, G. B. Hanna et al.
Notes: Breath test for pancreatic cancer
Authors: S. Gasteiger, B. Cardini, G. Göbel, R. Oberhuber, F. Messner, T. Resch et al.
Notes: Good outcome in selected patients
Meta‐analysis of the prognostic role of perioperative platelet count in posthepatectomy liver failure and mortality. BJS 2018; 105: 1254-1261.
Authors: A. Mehrabi, M. Golriz, E. Khajeh, O. Ghamarnejad, P. Probst, H. Fonouni et al.
Notes: Low platelets, worse outcomes
Meta‐analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma. BJS 2018; 105: 1408-1416.
Authors: N. T. E. Bird, A. McKenna, J. Dodd, G. Poston, R. Jones, H. Malik et al.
Notes: Tumour biology is important
Randomized clinical trial
Randomized clinical trial of stapler hepatectomy versus LigaSure™ transection in elective hepatic resection. BJS 2018; 105: 1119-1127.
Authors: J. Fritzmann, J. Kirchberg, D. Sturm, A. B. Ulrich, P. Knebel, A. Mehrabi et al.
Neoadjuvant chemotherapy response influences outcomes in non‐colorectal, non‐neuroendocrine liver metastases.
Authors: A. M. Lucchese, A. N. Kalil, A. Ruiz, V. Karam, O. Ciacio, G. Pittau et al.
Notes: Multimodal therapy works
Authors: B. Groot Koerkamp, W. R. Jarnagin
Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. BJS 2018; 105: 1182-1191.
Authors: M. C. Halls, G. Berardi, F. Cipriani, L. Barkhatov, P. Lainas, S. Harris et al.
Notes: Helps improve selection for laparoscopic liver resection