Role of posterosuperior pancreatic lymph nodes in gallbladder cancer: A study using the efficacy index

Gallbladder cancer (GBC) is an aggressive malignancy with a poor prognosis, for which radical surgery, including lymph node (LN) dissection, remains the only potentially curative treatment. However, the optimal extent of LN dissection has yet to be sufficiently established. The present study sought to evaluate different LN dissection strategies by analyzing the patterns of LN metastasis and calculating the lymph node dissection efficacy index (EI) for each nodal station. A retrospective analysis was conducted on 42 patients with GBC who underwent gallbladder bed resection or more extensive procedures with LN dissection. The prognostic outcome of each LN dissection was assessed using the EI. LN metastases and recurrence were identified in 12 and 14 patients, respectively. Among the four patients with negative metastasis in the hepatoduodenal ligament (LN#12) and positive metastasis in the posterosuperior pancreatic LN (LN#13a), one case remained recurrence-free. Compared with LN along the common hepatic artery (LN#8, 2.94) and LN#12 (4.76), the highest EI value (5.88) was obtained for LN#13a, thereby highlighting its utility in surgical management. Overall, LN#13a might be considered regional nodes for GBC, and should accordingly be dissected, and even in cases in which intraoperative sampling reveals no metastasis in LN#12, dissection of LN#13a warrants consideration.