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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 1/2018

01-01-2018 | 2017 SSAT Plenary Presentation

Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status

Authors: Eduardo A. Vega, Eduardo Vinuela, Suguru Yamashita, Marcel Sanhueza, Gabriel Cavada, Cristian Diaz, Thomas A. Aloia, Yun Shin Chun, Ching-Wei D Tzeng, Masayuki Okuno, Claire Goumard, Jean-Nicolas Vauthey, Jeffrey E. Lee, Claudius Conrad

Published in: Journal of Gastrointestinal Surgery | Issue 1/2018

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Abstract

Background

We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus indicates whether an oncologic extended resection (OER) is required.

Methods

The study included patients who underwent OER for incidental gallbladder cancer (IGBC) during 1999–2015. Associations between a positive cystic duct node and D2 nodal status and disease-specific survival (DSS) were analyzed.

Results

One-hundred-eight-seven patients were included. Seventy-three patients (39%) had the incidental cystic duct node retrieved. Cystic duct node positivity was associated with positive D1 (odds ratio 5.2, p = 0.012) but not with D2. Among all patients, a positive cystic duct node was associated with worse DSS (hazard ratio [HR] 2.09). Patients without residual cancer at OER and positive incidental cystic duct node had similar DSS to patients with negative nodes 70 vs 60% (p = 0.337). Positive D1 (HR 6.07) or positive D2 (HR 13.8) was predictive of worse DSS.

Conclusions

Patients with no residual cancer at OER and regional disease limited to their incidental cystic duct node have similar DSS to pN0 patients. The status of the cystic duct node only predicts the status of hepatic pedicle nodes.
Appendix
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Metadata
Title
Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status
Authors
Eduardo A. Vega
Eduardo Vinuela
Suguru Yamashita
Marcel Sanhueza
Gabriel Cavada
Cristian Diaz
Thomas A. Aloia
Yun Shin Chun
Ching-Wei D Tzeng
Masayuki Okuno
Claire Goumard
Jean-Nicolas Vauthey
Jeffrey E. Lee
Claudius Conrad
Publication date
01-01-2018
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3507-x

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