Lymph node metastasis, dissection efficacy, and prognostic differences between direct and incidental gallbladder...

Gallbladder carcinoma (GBC) has a poor prognosis, with lymph node metastasis (LNM) being a key prognostic factor. Controversies remain regarding lymph node dissection (LND) utility and prognostic differences of direct (DGBC) vs. incidental (IGBC) GBC.

Retrospective analysis of 193 GBC patients who underwent radical resection (2012.2-2024.9). Patients were categorized in two ways: first by LNM status (LNM group vs. LN0 group) and second by GBC type (DGBC group vs. IGBC group). Clinical, pathological, and follow-up data were collected; survival analyses used Kaplan-Meier (KM) curves with log-rank tests, and prognostic/predictive factors were analyzed via Cox regression and Logistics regression.

Of 193 patients, 37% (72/193) had LNM (most common in LN12: 81.9%), which significantly reduced Overall Survival (OS: median 22.95 vs. 46.30 months, P < 0.0001) and Recurrence-Free Survival (RFS: median 13.25 vs. 41.70 months, P < 0.0001) vs. LN0 group. The most common LNM sites in GBC occur at No.12 (30.57%), No. 13 (13.47%), and No.8 (11.40%) LNs. LND did not improve OS (P = 0.14) or RFS (P = 0.96) in GBC patients. IGBC (45/193) had better OS (88.89% vs. 60.14%, P = 0.0007) and RFS (median 39.60 vs. 20.70 months, P = 0.0473) than DGBC, with lower LNM rates (especially No.12: P = 0.0006) and milder pathological features (lower T stage, less hepatic or nerve invasion). However, LND still failed to improve survival of IGBC patients.

LNM is a critical negative prognostic factor for GBC. LND serves staging and treatment planning, not survival improvement. Routine LND is unnecessary for IGBC, providing evidence for personalized GBC management.