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

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gallbladder carcinoma (GBC) presents a poor prognosis, with lymph node metastasis (LNM) being a critical determinant of patient outcomes.
• Existing debates surround the therapeutic utility of lymph node dissection (LND) and the prognostic distinctions between direct (DGBC) and incidental (IGBC) GBC.

Purpose of the Study:

• To investigate the prognostic impact of LNM in GBC patients.
• To evaluate the survival benefit of LND in GBC.
• To compare the clinical and pathological characteristics and survival outcomes of DGBC versus IGBC.

Main Methods:

• Retrospective analysis of 193 GBC patients undergoing radical resection.
• Patients were stratified by LNM status and GBC type (DGBC vs. IGBC).
• Survival outcomes were analyzed using Kaplan-Meier curves and log-rank tests; prognostic factors were assessed via Cox and Logistics regression.

Main Results:

• LNM was identified in 37% of patients and significantly reduced overall survival (OS) and recurrence-free survival (RFS).
• Common LNM sites included No. 12, 13, and 8 lymph nodes.
• LND did not improve OS or RFS in the overall GBC cohort or in IGBC patients. IGBC demonstrated superior OS and RFS compared to DGBC, with lower LNM rates and less advanced pathological features.

Conclusions:

• LNM is a significant negative prognostic factor in GBC.
• LND primarily aids in staging and treatment planning rather than directly improving survival.
• Routine LND is not recommended for IGBC, supporting a tailored approach to GBC management.