Node positivity in T1b gallbladder cancer: A high volume centre experience.

Area of Science:

• Surgical Oncology
• Gastrointestinal Cancer Research
• Pathology

Background:

• Early identification of gallbladder cancer (GBC) is challenging.
• Simple cholecystectomy is curative for T1a GBC, but T1b GBC necessitates radical surgery due to potential lymph node metastasis.
• Optimal treatment for T1b GBC remains debated.

Purpose of the Study:

• To evaluate the significance of lymph node status in T1b GBC.
• To determine the optimal surgical approach for T1b GBC.
• To analyze outcomes based on nodal positivity in T1b GBC patients.

Main Methods:

• Retrospective analysis of 76 T1b GBC patients operated between March 2010 and March 2021.
• Patients were categorized into node-positive (n=16) and node-negative (n=60) cohorts.
• Median follow-up was 47.5 months.

Main Results:

• Lymph node positivity rate was 21% (16/76).
• Node-positive patients had significantly higher recurrence rates (43% vs. 8.3%) and lower 3-year overall survival (OS) and disease-free survival (DFS) (75%/62.5% vs. 96.7%/91.7%).
• All recurrences in node-positive cases involved periportal nodes, distant nodes, or liver metastasis.

Conclusions:

• Nodal positivity in T1b GBC is approximately 21%.
• Radical surgery including complete peri-portal lymphadenectomy should be the standard of care for T1b GBC.
• Prompt surgical intervention is crucial for improving patient outcomes.