Extent of lymph node dissection in patients with gallbladder cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Regional lymph node (RLN) definitions for gallbladder cancer (GBC) lack standardization across different staging systems.
• This ambiguity hinders the establishment of appropriate lymph node dissection (LND) extent in clinical practice.

Purpose of the Study:

• To clarify the definition of regional lymph nodes for gallbladder cancer.
• To evaluate the prognostic significance of specific lymph node stations in patients undergoing surgical resection.

Main Methods:

• Retrospective review of 259 patients who underwent surgical resection for gallbladder cancer between 1990 and 2016.
• Patients were categorized into groups (Na, Nb, Nc) based on the location of nodal metastases: hepatoduodenal ligament/common hepatic artery (Na), posterosuperior pancreatic head lymph nodes (PSPLNs) (Nb), and coeliac axis/superior mesenteric vessels (Nc).
• Disease-specific survival (DSS) rates were analyzed in relation to nodal status (M0 vs. M1) and dissection extent.

Main Results:

• The 5-year DSS rate was similar for NaM0 and NbM0 disease (36% vs. 34%, P=0.950).
• Patients with NcM0 disease had significantly worse 5-year DSS (0%) compared to NbM0 (P=0.017) and similar rates to distant metastatic disease (M1) (14%, P=0.590).
• In NbM0 patients, pancreatoduodenectomy versus PSPLN dissection without pancreatoduodenectomy showed no significant difference in 5-year DSS (50% vs. 30%, P=0.499).

Conclusions:

• Posterosuperior pancreatic head lymph nodes (PSPLNs), along with nodes in the hepatoduodenal ligament and hepatic artery, should be classified as regional lymph nodes for gallbladder cancer.
• Resection of these identified regional lymph nodes is recommended for gallbladder cancer patients undergoing surgery.