[Value of paraaortic lymphadenectomy for gallbladder carcinoma]

Seven reports of paraaortic lymphadenectomy for advanced carcinoma of the gallbladder were reviewed and positive paraaortic nodes were found in 20-40% of the resected patients and 10-15% of those with subserosal cancer invasion. The rate of patients with positive paraaortic nodes/all patients with positive nodes was 30-50%. Paraaortic lymphadenectomy did not improve the surgical outcome, and most of the patients with positive paraaortic nodes died within 1 year even after aggressive surgery with extensive lymph node dissection. Therefore it is important to clarify the value of paraaortic lymph node dissection for patients with possibly positive paraaortic node metastasis and those with histologically positive nodes excluding the paraaortic area. Although pancreatoduodenectomy for prophylactic lymphadenectomy around the head of the pancreas has been carried out in some institutions, the procedure does not seem to be effective because the main lymphatic route from the gallbladder has a direct connection with the paraaortic nodes via the pericholedochal, periportal, and/or the posterior nodes along the common hepatic artery. The present authors recommend a D2 plus paraaortic lymph node dissection (ext D2) as a standard surgical strategy for carcinoma of the gallbladder.