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Erschienen in:
01.03.2015 | Hepatobiliary Tumors
Lymph Node Metastases in Patients Undergoing Surgery for a Gallbladder Cancer. Extension of the Lymph Node Dissection and Prognostic Value of the Lymph Node Ratio
Erschienen in: Annals of Surgical Oncology | Ausgabe 3/2015
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Background
Lymph node (LN) status is one of the strongest prognostic factors after gallbladder cancer (GBC) resection. The adequate extension of LN dissection and the stratification of the prognosis in N+ patients have been debated. The present study aims to clarify these issues.
Methods
A total of 112 consecutive patients who underwent operations for GBC with LN dissection were analyzed. Twenty-five patients (22.3 %) had D1 dissection (hepatic pedicle), and 87 (77.7 %) had D2 dissection (hepatic pedicle, celiac and retro-pancreatic area). The LN ratio (LNR) was computed as follows: number of metastatic LNs/number of retrieved LNs.
Results
The median number of retrieved LNs was 7 (1–35). Fifty-nine patients (52.7 %) had LN metastases (22 N2). D2 dissection allowed the retrieval of more LNs (8 vs. 3, p = 0.0007), with similar short-term outcomes. Common bile duct (CBD) resection (n = 41) did not increase the number of retrieved LNs. In five patients, D2 dissection identified skip LN metastases that otherwise would have been missed. LN metastases negatively impacted survival (5-years survival 57.2 % if N0 vs. 12.4 % if N+, p < 0.0001), but N1 and N2 patients had similar survival rates. The number of LN+ (1–3 vs. ≥4) did not impact prognosis. An LNR = 0.15 stratified the prognosis of N+ patients: 5-years survival 32.7 % if LNR ≤ 0.15 vs. 10.3 % if LNR > 0.15 (multivariate analysis p = 0.007).
Conclusions
A D2 LN dissection is recommended in all patients, because it allows for better staging. CBD resection does not improve LN dissection. An LNR = 0.15, not the site of metastatic LNs, stratified the prognoses of N+ patients.