Technical description of a regional lymphadenectomy in radical surgery for gallbladder cancer

The guidelines for resection of gallbladder cancer include a regional lymphadenectomy; yet it is uncommonly performed in practice and inadequately described in the literature. The present study describes the technique of a regional lymphadenectomy for gallbladder cancer, as practiced by the author.

After confirming resectability, the duodenum is kocherized. The dissection starts from the posterior aspects of the duodenum and head of the pancreas and extends superiorly to the retroportal area. This is followed by dissection of the common hepatic artery and its branches, the bile duct and the anterior aspect of the portal vein until the hepatic hilum. Resection of the gallbladder with an appropriate liver resection completes the surgery.

This technique was used for a regional lymphadenectomy in 27 patients, of which 14 underwent radical cholecystectomy upfront, and 13 had revisional surgery for incidentally detected gallbladder cancer. The median number of lymph nodes dissected on histopathology was 8 (range 3 to 18). Eleven patients had metastatic lymph nodes on histopathological examination. There was no post-operative mortality. Two patients had a bile leak which resolved with conservative management.

A systematic approach towards a regional lymphadenectomy ensures a consistent nodal harvest in patients undergoing radical resection for gallbladder cancer.