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Metastasis02:30

Metastasis

Metastasis is the spread of cancer cells from the original site to distant locations in the body. Cancer cells can spread via blood vessels (hematogenous) as well as lymph vessels in the body.
Epithelial-to-Mesenchymal Transition
The epithelial-to-mesenchymal transition or EMT is a developmental process commonly observed in wound healing, embryogenesis, and cancer metastasis. EMT is induced by transforming growth factor-beta (TGF-β) or receptor tyrosine kinase (RTK) ligands, which further...

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Retroperitoneal Lymph Node Metastasis in Gallbladder Cancer: As Bad as Distant Metastasis.

Nalini Kanta Ghosh1, Rahul Rahul1, Ashish Singh1

  • 1Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

South Asian Journal of Cancer
|January 2, 2023
PubMed
Summary

Retroperitoneal lymph node metastasis (RLNM) in gallbladder cancer patients indicates distant metastasis (DM), showing similar poor survival outcomes. Curative surgery should be avoided in patients with RLNM due to futility.

Keywords:
distant metastasisgallbladder cancerinteraortocaval lymph node metastasispara-aortic lymph-node metastasisretroperitoneal lymph node metastasis

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Pathology

Background:

  • Conflicting evidence exists regarding the classification of retroperitoneal lymph node metastasis (RLNM) in gallbladder cancer (GBC).
  • The role of radical curative surgery in the presence of RLNM remains debated.
  • This study investigates the impact of RLNM on GBC patient survival and compares it to distant metastasis (DM).

Purpose of the Study:

  • To determine the prognostic significance of retroperitoneal lymph node metastasis (RLNM) in gallbladder cancer (GBC).
  • To compare survival outcomes between GBC patients with RLNM and those with distant metastasis (DM).
  • To inform surgical decision-making for GBC patients with suspected RLNM.

Main Methods:

  • Retrospective analysis of a prospective database of GBC patients with RLNM or DM identified via frozen section biopsy.
  • Inclusion criteria: patients diagnosed between January 2013 and December 2018.
  • Statistical analysis using SPSS v22.0, with survival comparison via log-rank test (p < 0.05 significance).

Main Results:

  • Out of 235 patients, 91 (39%) had curative resection abandoned due to RLNM (20 patients, 9%) or DM (71 patients, 30%).
  • Median survival was 5 months (range 2-26) for RLNM and 6 months (range 2-24) for DM, with no significant difference (p=0.64).
  • No 3-year survivors were observed in either the RLNM or DM group.

Conclusions:

  • Retroperitoneal lymph node metastasis (RLNM) in gallbladder cancer (GBC) should be classified as equivalent to distant metastasis (DM) due to similar poor survival.
  • Evidence supports avoiding curative surgery in GBC patients with RLNM.
  • Preoperative or intraoperative sampling of suspicious lymph nodes is crucial to prevent futile surgical interventions.