Role of regional lymphadenectomy in different stage of gallbladder carcinoma

Lymph node spread is the most common pattern of progression in gallbladder carcinoma (GBC) and is a prognostic factor. The purpose of this study was to evaluate the curative effects of radical surgery including different extent of regional lymphadenectomy for patients with different stage of GBC.

A retrospective study was made of 91 patients who had undergone radical resection and regional lymphadenectomy from January 2001 to December 2006. The curative effects of radical surgery and survival rate were elucidated by different extent of regional lymphadenectomy according to the classification of lymph nodes according to the American Joint Committee on Cancer (AJCC) which is classified into two grades, standard regional lymphadenectomy and extended regional lymphadenectomy. The extent of standard regional lymphadenectomy includes lymph nodes around the cystic duct, pericholedochal and hepatoduodenal ligament. The extent of extended regional lymphadenectomy includes retroportal, posterosuperior pancreaticoduodenal, posteroinferior pancreaticoduodenal, along the common hepatic artery, celiac, superior mesenteric and interaorticocaval lymph nodes.

There was no significant difference of survival rates in patients with stage II between the standard regional lymphadenectomy and extended regional lymphadenectomy groups (P=0.109). However, to the patients with stage III and stage IV without distant metastases, when extended regional lymphadenectomy was performed, survival rates were significantly higher than those who received standard regional lymphadenectomy (P=0.009 and P=0.029, respectively).

The standard regional lymphadenectomy is enough for the patients with stage II. The extended regional lymphadenectomy should be performed to the patients with stage III and stage IV without distant metastases if the primary lesions can be dissected radically.