Lymphatic spread of T2 gallbladder carcinoma: Regional lymphadenectomy is required independent of tumor location |
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| Affiliation: | 1. Department of Interventional Radiology, Loma Linda University, 11234 Anderson St., Loma Linda, CA 92354;2. Department of Gastroenterology and Hepatology and Transplantation Institute, Loma Linda University, 11234 Anderson St., Loma Linda, CA 92354;1. Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA;2. Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA;1. Department of Surgical Oncology, Leiden University Medical Center, the Netherlands;2. Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands;3. National Cancer Registry, Brussels, Belgium;4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;5. Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden;6. Department of Surgery, Aarhus University Hospital, Aarhus, Denmark;7. Danish Colorectal Cancer Group (DCCG.dk), Copenhagen, Denmark;8. Department of Pathology, Herlev and Gentofte Hospital, Copenhagen, Denmark;9. Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands;10. Department of Public Health, Erasmus MC, Rotterdam, the Netherlands;11. Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands;12. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;13. GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands |
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| Abstract: | BackgroundThis study aimed to investigate the incidence and distribution of regional lymph node metastasis according to tumor location, and to clarify whether tumor location could determine the extent of regional lymphadenectomy in patients with pathological T2 (pT2) gallbladder carcinoma.MethodsIn total, 81 patients with pT2 gallbladder carcinoma (25 with pT2a tumors and 56 with pT2b tumors) who underwent radical resection were enrolled. Tumor location was determined histologically in each gallbladder specimen.ResultsSurvival after resection was significantly worse in patients with pT2b tumors than those with pT2a tumors (5-year survival, 72% vs. 96%; p = 0.027). Tumor location was an independent prognostic factor on multivariate analysis (hazard ratio, 14.162; p = 0.018). The incidence of regional lymph node metastasis was significantly higher in patients with pT2b tumors than in those with pT2a tumors (46% vs. 20%; p = 0.028). However, the number of positive nodes was similar between the two groups (median, 2 vs. 2; p = 0.910). For node-positive patients with pT2b tumors, metastasis was found in every regional node group (12%–63%), whereas even for node-positive patients with pT2a tumors, metastasis was observed in regional node groups outside the hepatoduodenal ligament.ConclusionsTumor location in patients with pT2 gallbladder carcinoma can predict the presence or absence of regional lymph node metastasis but not the number and anatomical distribution of positive regional lymph nodes. The extent of regional lymphadenectomy should not be changed even in patients with pT2a tumors, provided that they are fit enough for surgery. |
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| Keywords: | Gallbladder neoplasms Tumor location Lymphatic metastasis Lymph node excision Lymphatic vessels Survival rate |
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