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Updated: Mar 2, 2026
Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection
Published on: January 9, 2026
Metástasis linfática, eficacia de la disección y diferencias pronósticas entre carcinoma de vesícula biliar directo e
Ke Xu1, Ruoyu Zhang1, Yimeng Yuan1
1Department of Hepatobiliary Surgery, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli Area, Chaoyang District, Beijing, 100021, China.
Aims:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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