Long-term survival of patients with biliary tract cancers with lymph node involvement

In extrahepatic biliary tract malignancies, the prognostic value of lymph node involvement remains unclear. For a total of 161 tumors of the gallbladder (GBC) and bile duct (BDC) resected between 1982 and 1992, the number and extent of metastatic nodes were investigated according to the location of the primary tumor. In GBCs and upper two-third BDCs, more than half of node-positive tumors involved multiple nodes (58% and 63%), and node-positive tumors were associated with a significantly poorer rate of patient survival compared with node-negative tumors. However, GBCs with one or two nodes involved resulted in a longer survival time than those with three or greater (P = 0.0045). In lower one-third BDCs, even patients with node-positive tumors showed a 60% 5-year survival rate. There were 15 long-term survivors (i.e., survived for more than 5 years after surgery) with node-positive tumors in the GBC group, 4 in the upper BDC group, and 6 in the lower BDC group. Thirteen GBCs had one or two involved nodes, and 12 of the 13 GBCs positive nodes were located within the hepatoduodenal ligament. In upper and lower BDCs, pericholedocal nodes and nodes around the pancreatic head respectively, were most frequently involved. We concluded that lymphatic spread is an important prognostic determinant in both GBCs and upper BDCs. The prognosis of GBCs is especially influenced by the number of nodes involved. In lower BDCs, lymphatic metastasis does not necessarily preclude long-term survival.