Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 14, 2012; 18(22): 2775-2783
Published online Jun 14, 2012. doi: 10.3748/wjg.v18.i22.2775
Regional lymphadenectomy for gallbladder cancer: Rational extent, technical details, and patient outcomes
Yoshio Shirai, Toshifumi Wakai, Jun Sakata, Katsuyoshi Hatakeyama
Yoshio Shirai, Toshifumi Wakai, Jun Sakata, Katsuyoshi Hatakeyama, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City 951-8510, Japan
Author contributions: Shirai Y conceived the study and drafted the manuscript; Wakai T performed chart review and follow-up of the study cohort; Sakata J helped to draft the manuscript and performed statistical analyses; Hatakeyama K was responsible for the whole study and participated in its coordination; all authors read and approved the final manuscript.
Supported by A grant from the Ministry of Education, Culture, Sports, Science and Technology in Japan, Grant-in-Aid for Scientific Research, No. 23592004
Correspondence to: Yoshio Shirai, MD, PhD, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan. shiray@med.niigata-u.ac.jp
Telephone: +81-25-2272228 Fax: +81-25-2270779
Received: January 21, 2011
Revised: February 28, 2012
Accepted: March 20, 2012
Published online: June 14, 2012
Abstract

AIM: To define the rational extent of regional lymphadenectomy for gallbladder cancer and to clarify its effect on long-term survival.

METHODS: A total of 152 patients with gallbladder cancer who underwent a minimum of “extended” portal lymph node dissection (defined as en bloc removal of the first- and second-echelon nodes) from 1982 to 2010 were retrospectively analyzed. Based on previous studies, regional lymph nodes of the gallbladder were divided into first-echelon nodes (cystic duct or pericholedochal nodes), second-echelon nodes (node groups posterosuperior to the head of the pancreas or around the hepatic vessels), and more distant nodes.

RESULTS: Among the 152 patients (total of 3352 lymph nodes retrieved, median of 19 per patient), 79 patients (52%) had 356 positive nodes. Among node-positive patients, the prevalence of nodal metastasis was highest in the pericholedochal (54%) and cystic duct (38%) nodes, followed by the second-echelon node groups (29% to 19%), while more distant node groups were only rarely (5% or less) involved. Disease-specific survival after R0 resection differed according to the nodal status (P < 0.001): most node-negative patients achieved long-term survival (median, not reached; 5-year survival, 80%), whereas among node-positive patients, 22 survived for more than 5 years (median, 37 mo; 5-year survival, 43%).

CONCLUSION: The rational extent of lymphadenectomy for gallbladder cancer should include the first- and second-echelon nodes. A considerable proportion of node-positive patients benefit from such aggressive lymphadenectomy.

Keywords: Gallbladder neoplasms; Lymphatic metastasis; Lymph node excision; Prognosis; Radical surgery